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i  N 

Nursing 


ETERNITY,  IN  FAN 

AND 

Childhood. 

ByJoHNM.K;  ID. 


RECAP 


Columbia  Untoersrttp 

COLLEGE  OF  PHYSICIANS 
AND   SURGEONS 


Reference  Library 

Given  by 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/maternityinfancyOOkeat 


PRACTICAL  LESSONS  IN  NURSING. 

12mo.    Extra  Cloth.    $1.00  each. 


CHAS.   K.    MILLS,    M.D. 

THE   NURSING  AND  CARE    OF   THE 

NERVOUS   AND    THE 

INSANE. 

JOHN    M.   KEATING,   M.D. 
MATERNITY;  INFANCY;   CHILDHOOD. 

The  Hygiene  of  Pregnancy;  the  Nursing  and  Weaning 

of  Infants  ;  the  Care  of  Children  in 

Health  and  Disease. 

E.    T.  BRUEN,    M.D. 

OUTLINES    FOR    THE    MANAGEMENT 

OF    DIET; 

Or,  the  Regulation  of  Food  to  the  Requirements  of  Health  and 
the  Treatment  of  Disease. 

J.   C.  WILSON,    M.D. 

FEVER  NURSING. 

including: 
i.     On  Fever  Nursing  in  General. 
2.     Scarlet  Fever. 

3.     Enteric  or  Typhoid  Fever. 

4.     Pneumonia  and  Rheumatism. 

For  sale  by  all  Booksellers,  or  will  be  sent,  free  of  postage,  on  receipt  of  the 
price  by  the  Publishers,  J.  B.  Lippincott  Company,  715  and  717  Market  St., 
Philadelphia. 


PRACTICAL  LESSONS  IN  NURSING. 

Maternity,  Infancy, 
Childhood. 


HYGIENE  OF  PREGNANCY;  NURSING  AND  WEANING 

OF  INFANTS;  THE  CARE  OF  CHILDREN 

IN  HEALTH  AND  DISEASE. 


ADAPTED    ESPECIALLY    TO    THE    USE    OF    MOTHERS    OR    THOSE 

INTRUSTED    WITH     THE    BRINGING    UP    OF    INFANTS    AND 

CHILDREN,   AND   TRAINING   SCHOOLS  FOR   NURSES,   AS 

AN  AID    TO    THE    TEACHING    OF    THE    NURSING 

OF  WOMEN  AND   CHILDREN. 


BY 

JOHN  M.  KEATING,  M.D., 

VISITING     OBSTETRICIAN   AND    LECTURER    ON   THE   DISEASES   OF   WOMEN   AND 

CHILDREN,     PHILADELPHIA     HOSPITAL    (BLOCKLEY)  ;     FELLOW     OF 

THE    COLLEGE   OF   PHYSICIANS   OF   PHILADELPHIA,  ETC. 


is  Huber 


SECOND   EDITION. 


PHILADELPHIA: 

J.   B.   LIPPINCOTT    COMPAl^Y. 

London:   10  Henrietta  Street,  Cotent  Garden. 
1888. 


Copyright,  1887,  by  J.  B.  Lippincott  Company. 


TO 


J.  M.  DA  COSTA,  M.D.,  LL.D., 

PROFESSOR   OF   THE    PRINCIPLES   AND    PRACTICE   OF   MEDICINE,   JEFFERSON 
MEDICAL   COLLEGE, 


IN  RECOGNITION  OF   MANY  ACTS   OF 
PERSONAL   KINDNESS. 


PKEFAOE. 


This  little  work  is  intended  for  mothers,  and  for 
those  who  have  undertaken  the  care  of  infants  and 
children  in  health  and  sickness.  The  enormous  mortal- 
ity of  children  under  three  years  of  age,  the  greater 
part  of  which  is  preventable,  has  attracted  the  notice 
not  only  of  physicians,  who  have  long  ago  insisted 
that  the  methods  adopted  in  general  for  the  weaning 
of  children  were  unscientific,  but  of  the  public  also, 
who  are  beginning  to  realize  this  fact,  and  now  will- 
ingly accept  the  advice  of  those  who  are  giving  espe- 
cial attention  to  the  subject. 

Much  of  the  material  appearing  in  this  book  has 
been  taken  from  the  manuscripts  of  my  lectures  to 
students  of  medicine  and  also  pupils  of  training  schools 
for  nurses. 

I  sincerely  hope  that  the  practical  nature  of  many  of 
the  suggestions  offered  will  find  favor  with  the  busy 
practitioner  of  medicine,  and  be  looked  upon  as  a  sup- 
plement to  the  text-books  on  children's  diseases  that 
cannot  give  space  to  details  of  nursing. 

To  Dr.  Charles  S.  Turnbull  I  am  indebted  for  the 
article  on  the  care  of  the  ear  and  eye,  one  of  the  most 
important  chapters  in  the  book. 

Dr.  Alexander  W.  MacCoy  kindly  replied  to  some 
questions,  and  the  matter  is  so  practical  and  clear  that 
I  have  placed  it  in  a  chapter  as  sent  me. 

1504  Walnut  Street,  Philadelphia. 


CONTENTS. 


PART   I. 

MATERNITY. 

CHAPTER    I. 

PREGNANCY. 


PAGE 


How  to  Calculate  the  Probable  Date  of  Confinement — The 
Presumptive  Evidences  of  Pregnancy — Morning  Sickness ; 
the  Cause,  and  how  to  Eemedy  it — How  to  Avoid  and 
Remedy  the  Constipation  of  Pregnancy — Exercise,  and  how 
it  should  be  taken — Diet  during  Pregnancy — The  Care 
which  the  Breasts  should  receive — The  Baby-Basket — A 
List  of  Articles  necessary  in  Confinement — The  Binder 
— Miscarriage ;  what  is  Meant  by  the  Term — The  most 
Frequent  Causes — The  Greatest  Care  and  Caution  should 
be  Exercised  after  Miscarriage 13 


IP  ART   II. 

INFANCY. 


CHAPTER   H. 

CARE  OF  NEW-BORN  INFANT. 
How  to  cleanse  a  New-born  Babe — The  Cord,  and  the  Care 
which  it  should  receive — The  Binder  and  its  Object — Im- 
portance of  noting  the  Child's  Secretions — A  Babe  should 
be  given  Water  occasionally — All  about  the  Mother's  Milk 
first  making  its  Appearance — The  Diet  of  the  Nursing 
Mother — How  to  check  an  excessive  flow  of  Milk,  and  to 
increase  an  Insufficient  Supply — The  Child's  Diet — How 
often  a  Child  should  receive  Nourishment 38 

CHAPTER    III. 

BOTTLE-FEEDING. 

The  Child's  Bottle  and  how  to  prepare  it — Great  Care  in  pre- 
paring the  Bottle  must  be  Exercised — An  Efficient  Nurse 
indispensable  to  the  Welfare  of  the  Child— A  Study  of 
Milk — Condensed  Milk  and  fresh  Evaporated  Milk  ....    50 

9 


10  CONTENTS. 

CHAPTER  TV. 

PREPARED  BOTTLE.  vkm 

Cow's  Milk,  its  Advantages  and  Disadvantages — A  Child's 
Digestion — Different  Preparations  of  Bottle-Pood — "Why 
an  Infant  should  have  very  Little  Starchy  Pood  in  its  Diet 
— How  to  avoid  either  Constipation  or  Diarrhoea — A  Bahy's 
Bottle  Diet  may  be  varied — Peptonized  Milk — The  Care 
which  a  Mother  should  exercise  in  the  Selection  of  a  Child's 
Diet 66 

CHAPTER  V. 

"WEANING. 

Weaning — "When  to  wean  a  Child — "Where  to  wean  a  Child ; 
and  how  to  wean  it 83 

CHAPTER  VI. 

FRESH  AIR,  VENTILATION,  OUT-DOOR  EXERCISE. 
The  Great  Importance  of  Ventilation — The  Selection  and 
Care  of  the  Nursery — How  it  should  he  Heated — The 
Danger  of  allowing  Children  to  be  left  to  the  Care  of 
Young  and  Inexperienced  Girls — How  Children  frequently 
contract  Diseases 87 

CHAPTER  VII. 

BATHING. 
The  Importance  of  Bathing — A  Child's  Time  for  Bathing 
must  be  regulated  by  the  Child's  Condition,  etc. — The 
Cruelty  of  forcing  Young  Children  to  have  a  Plunge  in 
the  Cold  Sea — A  Child  should  love  its  Bath,  and  how  it 
can  be  taught  to  love  it 94 

CHAPTER  VIII. 

TEETHING. 

The  Milk-Teeth,  and  when  they  are  usually  Cut — Why  a 
Slobbering  Babe  suffers  less  from  its  Teeth  than  another — 
Usual  Symptoms — "Why  Mothers  dread  a  Child's  Second 
Summer — Pickets  and  what  is  meant  by  the  Term — Pick- 
ets a  Prequent  Cause  of  Spinal  Affection — How  a  Pregnant 
"Woman  may  predispose  her  Child  to  Pickets — Fat  Children 
are  not  always  healthy  ones — How  to  treat  a  Eickety  Child 
— A  Teething  Child  suffers  frequently  from  other  Causes 
than  its  Teeth — A  Child  should  have  Sufficient  Sleep — 
"Why  so  many  Little  Ones  are  wakeful — How  Sleeplessness 
can  be  remedied — The  Diet  of  a  Teething  Child      ....  100 


CONTENTS.  11 

CHAPTER  IX. 

DIET  AFTER  EARLY  DENTITION.  pA(ffl 

The  Necessity  of  a  Careful  Selection  of  Diet — The  Advan- 
tages and  the  Disadvantages  of  taking  a  Child  to  the  Table 
— The  Necessity  of  discriminating  between  Children  as  to 
their  Diet — Why  what  is  Meat  to  one  Child  is  Poison  to 
Another — Exercise  is  Essential 112 

CHAPTER   X. 

ON  THE  BOWELS. 
What  constitutes  a  Normal  Condition  of  the  Bowels  in  a 
Child — More  Grease  than  Powder  should  he  used  for 
Young  Children — What  causes  Disturbances  of  the  Bow- 
els— Different  Causes  of  Constipation — How  Constipation 
can  he  overcome — Of  what  a  Child's  Diet  should  consist, 
and  how  it  can  be  regulated  when  it  is  suffering  from 
Bowel-Complaints — A  few  Useful  Bernedies — Exercise  a 
Specific  for  many  Forms  of  Constipation 116 


PART   III. 
CHILDHOOD. 


CHAPTER  XL 

ACUTE  AND  CHRONIC  NASAL  CATARRH. 
Affections  of  the  Mucous  Membrane  of  the  Nose,  Acute  and 
Chronic,  in  Infants  and  Children — Their  Prevention  and 
Treatment       127 

CHAPTER  XII. 

DISEASES  OF  THE  EAR  AND  EYE. 
Diseases  of  the  Ear  in  Infancy  and  Childhood — The  Care  of 
the  Ear  in  Childhood — Diseases  of  the  Eye  in  the  New- 
horn — Treatment  of  Simple  Ophthalmia — Contagious  Oph- 
thalmia ;  how  to  prevent  it ;  its  Treatment  and  Nursing    .  135 

CHAPTER   XIH. 

DISEASES  OF  THE  THROAT  AND  AIR-PASSAGES. 
Croup  and  Diphtheria — Simple  Spasmodic  Croup,  what  its 
Symptoms  are  and  how  to  treat  it — Membranous  Croup, 
its  Symptoms  and  Treatment — The  Difference  between 
Membranous  Croup  and  Diphtheria — Diphtheria  as  a 
Cause  of  Membranous  Croup — The  Nursing,  and  the  Use 
of  Household  Kemedies  in  their  Treatment 161 


12  CONTENTS. 

CHAPTER  XIV. 

DIABEH03A.  PAQ3j 

The  Causes  of  Diarrhoea; — Over-feeding;  Tainted  Milk;  De- 
composition of  Food ;  Undigested  Starches  ;  Teething  ; 
Hot  Weather — Inflammatory  Diarrhoea — How  it  can  be 
avoided — Change  of  Diet  necessary,  also  Absolute  Quiet, 
Pure  Drinking- Water,  and  Presh  Air — The  Character  of 
the  Diet — Importance  of  Peptonized  Milk  and  Nutritious 
Injections 164 

CHAPTER  XV. 

WHOOPING-COUGH. 
Its  Character — Its  Complications — The  Nursing  of  it — Diet 
—Treatment 174 

CHAPTER  XVI. 

SCAELET   FEVEE. 

Its  Cause — The  Eeasons  why  it  does  not  appear  to  be  as  Con- 
tagious as  other  Similar  Affections — The  First  Symptoms 
— Its  Nursing — Complications — Sequela? 180 

CHAPTER  XVII. 

MEASLES. 
How  it  is  contracted — How  the  Contagion  is  carried — Why 
it  is  the  most  contagious  of  the  Eruptive  Diseases — The 
Peculiarity  of  the  Eruption — The  Dangers  of  Pulmonary 
Troubles  as  Complications  or  following  the  Disease — The 
Nursing 186 

CHAPTER  XVIII. 

SECOND   DENTITION. 
Forcing  in  Education  to  be  Condemned — What  is  Meant  by 
Second   Dentition — Complications   Due   to   Hereditary  or 
Acquired  Conditions — Rickets — How  it  is  to  be  Avoided 
—Diet  of  Children  at  this  Age — Clothing 191 

CHAPTER  XIX. 

PUBERTY. 
Puberty — The  Four  Second  Molars — The  tendency  to  Dis- 
turbance of  Digestion  at  this  Time — The  Importance  of 
Proper  Food  and  Clothing,  also  Freedom  from  Excitement 
and  the  use  of  Iron — First  Menstruation — Menstrual  Irreg- 
ularities— Hysteria — Dysmenorrhcea — The  Abase  of  Ano- 
dynes— The  Mother  the  proper  Confidant  of  her  Daughter.  200 


Maternity;  Infancy;  Childhood. 


PART    I. 

MATERNITY. 

CHAPTER   I. 

PKEGNANCY. 

How  to  Calculate  the  Provable  Date  of  Confinement — The  Pre- 
sumptive Evidences  of  Pregnancy — Morning  Sickness ;  the 
Cause,  and  how  to  Kemedy  it — How  to  Avoid  and  Kemedy  the 
Constipation  of  Pregnancy — Exercise,  and  how  it  should  be 
taken — Diet  during  Pregnancy — The  Care  which  the  Breasts 
should  receive — The  Baby-Basket — A  List  of  Articles  necessaiy 
in  Confinement — The  Binder — -Miscarriage ;  what  is  Meant  by 
the  Term — The  most  Frequent  Causes — The  Greatest  Care  and 
Caution  should  be  Exercised  after  Miscarriage. 

Conception  is  more  liable  to  take  place  either  im- 
mediately before  or  immediately  after  the  period,  and, 
on  that  account,  it  is  usual  when  calculating  the  date  at 
which  to  expect  labor  to  count  from  the  day  of  disap- 
pearance of  the  last  period.  The  easiest  way  to  make  a 
calculation  is  to  count  back  three  months  from  the  date 
of  the  last  period  and  add  seven  days ;  thus  we  might 
say  that  the  date  was  the  10th  of  June  :  counting  back 
three  months  brings  us  to  the  10th  of  March,  and  add- 
ing the  seven  days  will  bring  us  to  the  17th. 

Very  many  medical  authorities,  distinguished  in  this 
line,  have  stated  their  belief  that  women  never  pass 
more  than  two  or  three  days  at  the  most  beyond  the 

2  13 


14  MATERNITY. 

forty  weeks  conceded  to  pregnancy, — that  is,  two  hun- 
dred and  eighty  days  or  ten  lunar  months,  or  nine  cal- 
endar months  and  a  week.  About  two  hundred  and 
eighty  days  will  represent  the  average  duration  of 
pregnancy,  counting  from  the  last  day  of  the  last  period. 
Now,  it  must  be  borne  in  mind  that  there  are  many  dis- 
turbing elements  which  might  cause  the  young  married 
woman  to  miss  a  time.  Daring  the  first  month  of 
pregnancy  there  is  no  sign  by  which  the  condition  may 
be  positively  known.  The  missing  of  a  period,  espe- 
cially in  a  person  who  has  been  regular  for  some  time, 
may  lead  one  to  suspect  it;  but  there  are  many  at- 
tendant causes  in  married  life,  the  little  annoyances  of 
household  duties,  embarrassments,  and  the  enforced 
gayety  which  naturally  surrounds  the  bride,  and  these 
should  all  be  taken  into  consideration  in  the  discussion 
as  to  whether  or  not  she  is  pregnant.  But  then, 
again,  there  are  some  rare  cases  who  have  menstru- 
ated throughout  their  pregnancy,  and  also  cases  where 
menstruation  was  never  established  and  pregnancy 
occurred.  Nevertheless,  the  non-appearance  of  the 
period,  with  other  signs,  may  be  taken  as  presumptive 
evidence. 

The  exact  date  at  which  to  expect  confinement  is  an 
important  one  to  determine  for  many  reasons;  the  en- 
gagement of  a  nurse  is  dependent  upon  it,  the  choice 
of  a  nurse  being  a  matter  of  importance.  Great  diffi- 
culty attends  the  positive  diagnosis  of  pregnancy  until 
the  fourth  month,  although  there  are  many  presumptive 
evidences  of  its  existence.  Among  these  may  be  noted 
the  changes  in  the  breasts,  their  increasing  size  and 
fulness ;  they  become  larger  and  harder,  the  areola  (the 
dark  line  which  surrounds  the  nipple)  becomes  increased 
in  size  and  darker  in  color,  especially  in  brunettes; 
later  the  nipple  itself  becomes  larger  in  size  and  darker 
in  color,  and  here  and  there  in  the  dark  ring  surrounding 
it  will  appear  small  tumors  or  indurations,  that  stand 


PREGNANCY.  15 

out  very  prominently  :  these  are  glands.  In  the  mean 
time  the  breasts  themselves  become  very  sensitive,  there 
is  a  feeling  of  fulness,  the  clothing  fits  tightly,  and 
there  is  a  sense  of  congestion  •  these  changes  may  take 
place  without  the  existence  of  pregnancy, — such  cases, 
however,  being  rare, — but  these  signs  may  be  ranked  as 
presumptive  evidence,  particularly  if  they  follow  the 
absence  of  a  period  and  make  their  appearance  about 
the  sixth  week.  The  time  when  undoubted  signs  of 
pregnancy  appear  is  towards  the  end  of  the  fourth 
month,  and  even  then  it  would  require  the  greatest  cau- 
tion on  the  part  of  the  physician  as  to  a  positive  decla- 
ration of  its  existence, — until  the  sound  of  the  infant's 
heart  is  heard  distinctly  and  apart  from  the  pulse  of 
the  mother ;  soon  after  this  follow  the  movements  of 
the  child,  which  is  called  quickening. 

At  this  period  the  timid  and  anxious  wife  develops 
feelings  of  a  varied  character ;  doubts  will  arise  as  to 
what  the  future  will  bring  forth  :  will  she  be  a  fruitful 
woman  in  reality,  or  will  she  be  destined  to  go  through 
life  without  the  sacred  name  of  mother?  Strange 
emotions  will  be  aroused, — that  peculiar,  mysterious 
dread,  which  is  an  admixture  of  fear  and  longing, 
possibly  only  appreciated  by  those  who  have  gone 
through  a  like  experience.  With  it  all,  she  secretly 
welcomes,  with  all  the  fulness  of  her  heart,  the  child 
who  is  slowly  developing  within  her,  receiving  nourish- 
ment from  her  blood  and  dependent  upon  her  for  ex- 
istence; but  she  dreads  the  ordeal  through  which 
she  must  pass  before  pressing  that  infant  to  her  bosom. 
Then,  too,  the  uncertainty  of  her  life  and  that  of  her 
offspring  give  her  many  hours  of  anxiety.  Impres- 
sions from  very  slight  causes  are  made  more  deeply 
than  at  any  other  time ;  casual  remarks,  revolting 
sights,  histories  of  horror,  all  leave  an  indelible  stamp 
upon  her  sensitive  nervous  system,  and  in  silence  they 
come  before  her,  steal  upon  her  unawares,  and  require 


16  MATERNITY. 

the  strongest  effort  of  the  will  to  be  overcome.  It  is 
right  for  us  to  discuss  this  matter  freely  with  her,  to 
give  her  a  few  words  of  sympathy  and  caution, — words 
of  sympathy,  to  sustain  in  those  lonely  hours  when 
doubt  and  fear  are  crowded  upon  the  young  wife  who 
has  no  one  in  whom  she  can  confide.  Let  her  take 
courage ;  she  is  not  alone  in  her  trouble ;  hundreds  of 
her  sex,  who  one  year  ago  were  haunted  by  the  same 
visions,  troubled  by  the  same  uncertainties  and  doubts, 
are  to-day  as  happy  mothers  as  their  fondest  wishes 
could  have  enabled  them  to  be. 

Pregnancy  is  not  a  disease,  it  is  a  normal  function  of 
woman,  and  this  should  be  impressed  upon  the  young 
wife  that  she  may  undertake  its  duties  and  responsi- 
bilities with  a  thorough  knowledge  of  its  requirements  ; 
that  she  may  submit  wisely  to  the  laws  of  hygiene, 
and  make  the  proper  preparation  for  the  event  which 
she  naturally  dreads.  It  is  the  natural  function  of 
woman  to  bear  children,  and  nature  endeavors  to  make 
all  her  functions  normal ;  and  diseases  or  disorders  of 
various  kinds  are  usually  brought  about  by  something 
which  is  controllable  or  avoidable.  We  would  not  have 
it  supposed  for  one  moment  that  we  propose  to  lay  down 
certain  cast-iron  rules  to  be  followed  in  every  case. 
There  being  all  kinds  and  conditions  of  women,  differ- 
ences existing  as  to  face,  temperament,  physical  health, 
social  position,  as  well  as  financial  status,  a  rule  which 
might  govern  one  in  her  diet,  occupation,  and  general 
hygiene,  might  not  govern  another.  The  object  of 
this  work  is  simply  to  state  as  clearly  as  possible,  in 
language  devoid  of  technical  expressions,  all  that  is  of 
interest  to  a  mother,  and  it  must  be,  of  course,  limited 
to  those  suo-o-estions  which  will  be  of  service  in 
ordinary  cases.  All  matters  that  differ  from  what  is 
here  written  should  be  referred  to  the  family  physician 
for  his  advice.  My  own  experience  leads  me  to  know 
that  there  are  hundreds  of  things  which  a  patient  for- 


PREGNANCY.  17 

gets  to  ask  her  doctor,  or  thinks  too  trivial  to  consult 
him  about,  which  she  should  know,  or  she  may  hesitate 
because  she  thinks  it  may  show  unparalleled  ignorance 
on  her  part,  and  she  dislikes  to  confess  it.  Having  read 
all,  then,  that  is  contained  in  this  little  work  on  the 
subject  which  interests  her  for  the  moment,  should  she 
desire  further  information  her  family  physician  is  the 
one  to  supply  it. 

It  would  be  difficult  to  place  in  order  all  the  im- 
portant means  to  secure  health  during  pregnancy,  but 
we  may  sum  them  up  in  the  statement  that  moderation 
in  all  things  is  a  fundamental  law  of  hygiene. 

There  are  many  ways  by  which  the  physician  can 
establish  pretty  conclusively  the  existence  of  pregnancy 
after  the  second  or  third  month.  After  it  has  been  fully 
determined  that  pregnancy  exists,  great  care  should  be 
taken  to  give  the  child  every  opportunity  to  reach  full 
term.  A  moment's  thought  will  convince  any  one  that 
the  close  relationship  existing  between  mother  and 
child,  which  continues  up  to  the  time  of  its  birth,  not 
only  influences  its  growth  and  development,  but  also, 
through  its  close  relationship,  impresses  upon  it  certain 
mental  characteristics. 

In  the  earlier  months  of  pregnancy  the  digestion 
becomes  difficult ;  in  many  cases  the  appetite  is  either 
lost  altogether  or  perverted  at  times ;  or  there  is  a 
capriciousness  which  will  give  rise  to  an  inordinate 
desire  for  food  of  a  kind  which  may  not  be  considered 
nutritious.  There  seems  at  times  to  be  a  demand  for 
certain  elements,  owing  possibly  to  the  withdrawal  of 
them  in  behalf  of  the  child,  which  in  the  process  of 
growth  needs  these  various  articles  to  form  certain 
tissues. 

When  on  the  subject  of  Rickets,  I  shall  dwell  at 
length  upon  this  matter,  because  it  is  a  disease  of  the 
child  which  proceeds  from  a  deficient  supply  of 
lime  in  its  constitution ;  the  child  frequently  needing 


18  MATERNITY. 

the  lime  to  form  its  bones,  and  if  it  does  not  get  it 
from  the  food  which  is  supplied  to  the  mother,  will 
withdraw  it  from  her  own  tissues.  It  is  scarcely 
necessary  to  call  attention  to  the  fact  that  the  lower 
animals  are  in  constant  search  of  food  that  will 
supply  these  cravings  of  nature.  The  character  of  the 
egg  laid  by  the  hen  will  depend  upon  the  kind  of  food 
she  gets  ;  she  will  seek  lime  for  the  shell,  and  if  she  does 
not  succeed  in  getting  it  the  shell  will  be  soft  or  thin. 
There  are  many  curious  records  of  the  craving  of 
women  for  articles  of  food,  and  if  possible,  when  such 
cravings  exist,  they  should  be  gratified  within  reason- 
able limits. 

Women  have  been  known  to  eat  earth  for  the  lime. 
This  craving  for  lime  exists  more  especially  toward  the 
latter  part  of  pregnancy,  at  which  time  food  should 
be  changed  accordingly. 

In  the  ordinary  mixed  diet  to  which  we  are  accus- 
tomed, a  large  amount  of  bone-forming  material  is 
always  present ;  elsewhere  in  this  work  I  shall  explain 
the  whole  subject  of  digestion,  in  order  that  the  mother 
may  have  a  clear  understanding  of  the  subject  with 
reference  to  the  feeding  of  the  child.  Indigestion  should 
be  avoided.  This  is,  as  we  all  know,  easily  caused 
by  late  suppers,  eating  when  one  is  fatigued,  a  heavy 
breakfast  in  which  hot  cakes  are  one  of  the  principal 
articles,  the  excessive  use  of  tea  or  coffee,  and  similar 
indiscretions.  The  extent  to  which  one  may  indulge 
depends  upon  an  individual  law  for  each  individual 
case ;  and  we  all  know,  without  any  deep  study,  exactly 
how  much  and  what  we  can  eat,  but  I  fear  we  are  fre- 
quently but  too  willing  to  run  a  little  risk. 

In  the  earlier  stages  of  pregnancy  there  is,  as  we 
have  before  stated,  frequently  a  disturbance  in  the 
digestive  functions,  which  gives  rise  to  a  great  deal  of 
annoyance,  and  at  times  may  become  quite  a  serious 
consideration ;  particularly  if  it  prevents  the  taking  of 


PREGNANCY.  19 

nourishing  food,  or  produces  strain  from  excessive 
vomiting. 

In  many  instances  it  does  not  need  the  actual  pres- 
ence of  food  in  the  stomach  to  produce  it ;  it  comes  on 
at  the  earliest  waking,  and  is  often  compared  to  the 
sensation  of  nausea  which  we  have  all  experienced  from 
want  of  food.  At  other  times  it  seems  to  arise  from  the 
presence  of  food  in  the  stomach,  and  the  breakfast  is  no 
sooner  taken  than  violent  nausea  and  vomiting  follow ; 
the  matter  expelled  being  extremely  bitter,  due  possibly 
to  a  certain  amount  of  bile  collected  in  the  stomach. 

The  first  food  entering  the  stomach  will  likely  be 
rejected;  but  after  being  relieved,  a  meal  will  then  be 
retained  with  perfect  ease  and  comfort.  Though  called 
morning  sickness,  this  nausea  differs  with  different 
individuals;  some  complaining  of  it  in  the  evening 
and  others  in  the  earlier  hours  of  the  day. 

There  is  frequently  in  connection  with  this  disturb- 
ance the  regurgitation  of  intensely-acid,  burning,  watery 
material,  which  is  very  annoying,  and  is  usually  ac- 
companied by  heartburn.  This  can  be  held  in  abeyance 
by  some  alkali,  particularly  one  which  has  a  lax- 
ative effect ;  from  one-half  to  one  teaspoonful  of 
light  magnesia,  taken  in  water  at  bedtime,  the  frequent 
use  of  bicarbonate  of  soda,  or  the  preparation  known 
as  soda-mint,  either  in  solution  or  the  compressed  pills, 
will  give  relief.  When  not  contraindicated  by  persist- 
ent constipation,  lime-water  and  milk,  in  the  proportions 
of  one  tablespoonful  of  lime-water  to  an  ordinary  glass 
of  milk,  may  be  taken  freely  with  very  good  results. 
Sometimes  certain  odors  will  induce  nausea  :  they  may 
be  disagreeable  ones,  as  those  arising  from  cooking,  and 
again  the  most  fragrant  flowers  may  produce  the  same 
effect.  So  apt  is  this  to  occur  that  the  odors  of  various 
plants,  which  are  at  other  times  agreeable,  will  during 
the  earlier  months  of  pregnancy  be  decidedly  nau- 
seating, and  frequently  be  the  first  sign  of  the  existence 


20  MATERNITY. 

of  this  condition.  Not  only  does  the  sense  of  smell 
show  extreme  delicacy  as  the  result  of  this  reflex  stimu- 
lation, but  all  the  other  organs  of  special  sense  may  be 
equally  affected ;  for  instance,  the  taste,  eyesight,  or 
hearing  may  be  subject  to  the  same  disturbances. 

The  nausea  in  ordinary  cases  usually  passes  off  by 
the  third  or  fourth  month;  sometimes  it  lasts  longer, 
frequently  continuing  until  labor  sets  in.  It  is  one  of 
the  most  distressing  symptoms  of  pregnancy,  and  this, 
with  the  heartburn  which  usually  attends  it,  often  resists 
all  the  means  to  which  one  would  resort  under  ordinary 
circumstances.  Should  this  be  the  case,  consult  your 
family  physician  as  soon  as  possible. 

For  morning  sickness  we  may  mention  the  value  of 
some  light  nourishment  in  small  quantities  taken  either 
before  or  immediately  after  first  rising ;  such  as  a  cup 
of  chocolate,  coffee,  cocoa,  a  cup  of  good  broth  well  sea- 
soned, a  glass  of  champagne,  or  brandy  and  cracked 
ice;  a  seidlitz  powder  or  half  of  one  even,  or  a  claret 
glass  of  Congress  water,  taken  before  rising,  will  fre- 
quently control  the  nausea.  Should  there  be  excessive 
heartburn,  from  fifteen  to  twenty  drops  of  aromatic 
spirits  of  ammonia  in  a  wineglass  of  water,  or  a  mix- 
ture of  equal  parts  of  lime-water  and  milk,  will  have  a 
very  beneficial  effect. 

Frequently  five  drops  of  the  wine  of  ipecac  in  a 
wineglass  of  water,  given  at  intervals  of  from  ten  to 
fifteen  minutes,  will  check  the  nausea. 

As  this  nausea  is  not  dependent  upon  any  disturbance 
in  the  stomach  itself,  but  is  reflex,  it  can  frequently  be 
avoided  by  attending  to  the  precautionary  measures  of 
which  we  will  make  mention. 

The  patient  must  endeavor,  notwithstanding  the  un- 
settled state  of  her  stomach,  to  take  sufficient  nourish- 
ment during  the  day,  even  at  this  early  period.  Very 
often  a  brisk  walk,  a  little  wine  or  cordial,  or  a  glass 
of  malt  extract,  which  is  both  nourishing  and  stimu- 


PREGNANCY.  21 

lating,  or  some  preparation  of  pepsin,  as  lacto-peptine, 
for  instance,  if  taken  before  a  meal  will  cause  it  to  be 
retained.  Should  there  be  craving  after  an  unusual 
article  of  diet  at  any  time,  the  matter  should  be  referred 
to  the  physician,  and  possibly  the  substance  which  na- 
ture seems  to  demand  may  be  supplied  by  medicinal 
means,  or  the  diet  be  so  arranged  as  to  include  those 
articles  which  would  at  first  seem  questionable,  as 
pickles,  etc. 

DIET  AND   HYGIENE. 

It  is  well  that  the  patient  should  have  regular  habits 
from  the  very  commencement  of  this  condition,  if  pos- 
sible. I  would  not  have  it  supposed,  however,  that  she 
must  be  restricted  to  those  subjects  mentioned  in  the 
limits  of  this  article.  A  few  hints  may  be  of  advan- 
tage as  suggesting  the  proper  course  to  pursue. 

Upon  awaking  in  the  morning,  a  small  cup  of  black 
coffee,  cocoa,  or  chocolate  should  be  taken  before  rising ; 
she  should  then  take  a  bath  or  sponging,  to  invigorate 
the  system  and  restore  circulation ;  if  possible,  she 
should  then  take  a  short  walk  before  breakfast- 
One  is  frequently  asked  whether  a  bath  is  not  contra- 
indicated  at  this  time.  By  a  bath  we  do  not  mean  a 
plunge  into  ice-cold  water.  Cleanliness  is  never  contra- 
indicated  under  any  circumstances.  It  is  as  important 
to  have  a  full  action  of  the  skin  as  of  the  kidneys  or 
bowels.  A  bath  of  a  temperature  of  75°,  taken  in  a 
warm  room,  followed  by  a  gentle  surface  rubbing  or 
a  gentle  massage  to  the  limbs,  would  be  of  great  service 
and  should  be  insisted  upon  ;  but  if  a  bath  cannot  be 
taken,  a  rapid  sponging  of  the  body  should  not  be 
omitted.  There  are  some  persons  who  find  it  suits 
them  better  to  take  a  bath  at  night ;  this  is  not  a  mere 
matter  of  fancy,  and  I  think  can  be  safely  left  to  the 
patient's  judgment.  As  for  hot  baths,  except  those 
used  occasionally  simply  for  the  purpose  of  cleanliness, 


22  MATERNITY. 

unless  followed  by  a  cold  douche  they  are  beyond  a 
doubt  debilitating,  and  the  sudden  action  of  cold  water 
might  be  attended  by  serious  results.  We  simply  warn 
against  extremes. 

At  breakfast  the  patient  should  take  either  a  broiled 
mutton-chop,  one  that  is  thick  and  juicy,  or  a  piece  of 
tender  steak,  bread  and  butter,  with  one  of  the  cereals, 
either  oatmeal  or  cracked  wheat,  in  which  the  whole 
grain  is  crushed,  or  yellow  corn ;  these  can  be  varied 
according  to  fancy.  Eggs  and  oysters  should  be  used 
freely ;  if  possible  a  pint  of  milk,  or  cream,  should  be 
taken  at  each  meal ;  this  will  supply  bone,  muscle,  and 
nerve,  and  at  the  same  time  nourish  the  child, — not  at 
the  expense  of  the  mother's  own  strength  and  depriv- 
ing her  of  the  materials  which  are  essential  to  her  own 
well-being. 

The  dinner,  or  heavy  meal,  should  be  taken  in  the 
middle  of  the  day ;  in  the  evening  the  patient  should 
take  only  a  light  meal,  so  as  to  relieve  the  stomach  of 
its  digestive  burden  before  bedtime.  It  is  of  great 
importance  that  there  should  be  the  utmost  regularity 
in  taking  meals,  and  equally  so  that  there  be  a  diversity 
in  the  cooking.  Nature  requires  a  change ;  condiments 
stimulate  the  digestive  functions,  which  are  apt  to  be- 
come sluggish  owing  to  the  fact  that  the  stomach  is 
frequently  overloaded.  The  action  of  the  liver  being 
interfered  with,  the  bowels  become  sluggish,  attacks  of 
biliousness  supervene,  and  the  patient  loses  her  appetite 
and  becomes  emaciated. 

There  are  several  things  which  we  should  take  into 
consideration  in  discussing  the  dietary  in  the  pregnant 
state :  one  is  the  free  use  of  fruit  and  vegetables,  and 
the  other,  the  value  of  water  to  keep  in  solution  those 
materials  which  are  intended  to  be  thrown  off, — the 
ashes  of  the  food,  as  it  were,  and  the  waste  resulting 
from  the  destruction  of  tissue.  For  an  average  indi- 
vidual, taking  a  fair  amount  of  exercise,  five  pints  of 


PREGNANCY.  23 

fluid  should  be  takeu  in  twenty-four  hours,  to  make 
up  for  the  loss  of  that  which  passes  away  by  the  kidneys, 
bowels,  skin,  and  breath ;  this  is  in  addition  to  about 
fifteen  ounces  of  fluid  contained  in  the  solid  food. 
It  is  for  this  reason  that  milk  should  form  a  large 
portion  of  the  diet  of  a  pregnant  woman,  and  that  she 
should  eat  freely  of  fruit,  which,  as  is  well  known, 
contains  a  large  amount  of  water.  If  such  a  diet  were 
more  generally  adopted,  the  use  of  purgatives  would 
not  be  required. 

Should  the  dinner-hour  be  late,  it  is  advisable  to  re- 
lieve the  fatigue  incident  to  household  duties,  or  the 
usual  shopping  and  visiting,  by  taking  a  mid-day  meal 
consisting  principally  of  milk  or  some  light  farinaceous 
food,  a  milk-punch  with  an  egg  beaten  up  in  it,  a  few 
biscuits  with  a  glass  of  HofFs  malt, — something  light 
and  easily  digested, — after  having  taken  a  nap,  in  order 
to  avoid  the  great  fatigue's  interfering  with  digestion. 
This  should  be  done  invariably. 

CONSTIPATION. 

One  of  the  most  important  matters  for  our  consider- 
ation is  that  referring  to  the  regulation  of  the  bowels. 
Habit,  of  course,  is  the  best  laxative  upon  which  one 
can  depend ;  no  duties,  however  pressing,  should  at 
any  time  interfere.  It  is  usually  the  custom  for  persons 
to  have  a  movement  of  the  bowels  after  the  first  meal 
in  the  morning ;  the  presence  of  food  or  warm  drinks 
in  the  stomach  acts  as  a  reflex  stimulant. 

With  many,  the  hour  that  is  chosen  is  just  before  re- 
tiring ;  the  presence  of  a  full  rectum  crowding  the  con- 
tents of  the  abdomen,  and  the  gases  which  are  formed 
during  the  day,  making  the  patient  restless  and  un 
comfortable.  In  the  earlier  stages  of  pregnancy,  con- 
stipation is  very  apt  to  be  obstinate  and  annoying,  owing 
to  the  fact  that  the  womb  becoming  heavier  sinks  at 


24  MATERNITY. 

that  time  upon  the  rectum  and  causes  accumulation  to 
take  place. 

After  the  fourth  month  constipation  is  not  so  preva- 
lent ;  indeed,  not  until  the  eighth  month,  or  towards  full 
term,  does  it  again  become  annoying  in  many  cases. 
Constipation  may  be  produced  by  two  conditions,  one 
the  mechanical  pressure,  the  other  by  what  ordinarily 
is  known  as  biliousness,  which  in  reality  is  deficient 
action  of  the  liver  and  impairment  of  its  function,  by 
which  the  bile  is  either  not  secreted  or  else  it  fails  to  be 
passed  into  the  bowel.  In  individuals  who  take  little 
exercise,  no  fresh  air,  and  eat  heavily,  even  should  that 
eating  consist  only  of  extremely  nutritious  food,  very 
readily  digested,  the  liver  has  more  than  it  can  possibly 
manage,  the  bile  is  not  properly  made,  and  the  symp- 
toms of  biliousness  occur,  with  constipation.  The  tongue 
becomes  coated,  the  breath  heavy,  the  urine  is  high-col- 
ored, the  patient  complains  of  loss  of  appetite,  sleepless- 
ness, and  irritability. 

The  bile  has  various  uses  independent  of  its  action 
in  digestion ;  it  is  a  purgative  of  itself,  and  when  flow- 
ing freely  causes  regularity  in  the  bowel ;  it  is  an  anti- 
fermentative,  and  prevents  flatulence.  Constipation 
which  is  the  result  of  so-called  biliousness  demands  a 
variety  of  measures  by  way  of  treatment :  less  solid 
food,  more  fresh  air,  the  free  use  of  water, — pure  water. 

It  is  a  great  mistake,  and  a  very  serious  matter,  for 
a  person  who  is  pregnant  to  use  strong  purgatives,  un- 
less it  be  by  the  advice  of  a  physician.  The  bowels 
should  be  moved  by  habituating  herself  to  a  certain 
hour,  by  a  moderate  amount  of  exercise,  by  a  glass  of 
water  or  a  cup  of  chocolate  or  coffee  taken  the  first 
thing  in  the  morning,  by  eating  fruit,  raw  or  cooked, 
or  by  taking  a  glass  of  water  at  night  before  retiring. 
The  simplest  means  should  always  be  used  first.  Beef- 
tea  or  chicken  broth,  well  salted,  when  taken  before  re- 
tiring, is  quite  often  laxative. 


PREGNANCY.  25 

If  these  fail,  the  compound  liquorice  powder,  a  tea- 
spoon or  dessertspoonful,  can  be  taken  in  a  little  water 
or  milk.  A  wineglass  of  Hunyadi  water  taken  in  the 
morning,  two  or  three  times  a  week,  a  seidlitz  powder, 
or  the  patient  may  prefer  a  glass  of  Congress  water ; 
when  cold  and  sparkling  it  is  ndt  unpleasant  to  take, 
arrests  nausea,  and  acts  gently  upon  the  bowel.  The 
elixir  of  cascara  sagrada,  a  teaspoonful  taken  at  night, 
should  other  things  fail  or  become  monotonous,  or  a  tea- 
spoonful  of  maltine,  with  cascara,  taken  in  the  same 
way,  is  often  efficacious.  I  consider  it  unwise  to  sug- 
gest any  form  of  pills  for  the  patient  in  this  state  to 
take  without  consulting  the  physician. 

Constipation  sometimes  causes  swelling  of  the  left  leg 
or  enlargement  of  the  veins,  which  disappears  when  the 
bowels  are  regulated.  The  family  physician  should  al- 
ways have  his  attention  called  to  any  swelling  of  the 
body,  be  it  the  hands,  feet,  or  face,  as  it  may  be  a  very 
important  matter. 

Very  frequently  it  will  be  necessary  for  the  patient  to 
take  an  enema.  After  the  fourth  month,  this  should  be 
done  at  least  once  a  week ;  before  that  time  it  is  well  to 
consult  the  physician,  for  should  there  be  any  evidence  of 
threatened  miscarriage  it  might  be  productive  of  harm. 
It  is  not  at  all  essential  that  a  large  quantity  of  water 
be  injected  into  the  bowel  in  these  cases  in  order  to  get 
a  movement :  one  or  two  teacupfuls  of  warm  Castile 
soapsuds,  or  simply  warm  water  with  a  pinch  of  salt, 
will  be  all  that  is  required.  The  gluten  suppository 
made  by  the  Health  Food  Company  acts  admirably  in 
many  cases,  the  object  being  simply  to  avoid  all  strain- 
ing. Under  no  circumstances  should  a  strong  effort  at 
bearing  down  be  made.  The  Davidson  syringe  is  prob- 
ably the  most  convenient  to  use,  though  a  fountain 
syringe  often  serves  better. 

Mr.  Snowden,  an  instrument-maker  of  Philadelphia, 
has  made  for  me  what  we  call  a  traveller's  syringe.    It 

B  3 


26  MATERNITY. 

is  made  on  the  principle  of  an  ordinary  rubber  flower- 
sprinkler.  It  can  be  fully  charged  with  whatever  ma- 
terials are  to  be  used,  and  put  aside  until  the  most  con- 
venient time  to  use  it.  The  patient  can  readily  use  it 
herself,  which  is  a  great  advantage. 

The  best  time  for  an  enema  is  probably  upon  retiring. 

The  weight  in  the  abdomen,  and  the  displacement  of 
its  contents,  owing  to  the  increasing  size  of  the  child, 
causes  pressure  on  the  bladder,  and  frequently  gives 
rise  to  distressing  symptoms,  with  a  desire  to  pass 
water ;  of  course  these  cannot  be  relieved  entirely,  they 
must  be  recognized  as  physiological.  Standing  much 
upon  the  feet  or  walking  is  apt  to  increase  this,  therefore 
the  recumbent  position,  for  a  few  moments  at  a  time, 
is  the  most  desirable,  in  addition  to  relieving  the 
bladder  frequently.  Indeed,  during  the  earlier  months 
of  pregnancy  this  should  be  attended  to  with  great 
regularity,  for  often  thoughtlessness,  or  possibly  em- 
barrassment, will  permit  an  over-distended  bladder  to 
press  the  womb  out  of  its  position,  and  possibly  give 
rise  to  a  miscarriage. 

The  pressure  of  the  womb  and  its  contents  upon  the 
blood-vessels  in  the  abdomen  produces  at  times  not 
only  disturbances  in  the  action  of  the  liver,  but  also 
interferes  with  the  circulation  through  the  kidneys, 
and  if  allowed  to  continue  without  proper  medical 
treatment  might  produce  serious  disturbance ;  for  this 
purpose  it  is  usual  for  an  examination  of  the  urine  to 
be  made  frequently  during  the  course  of  pregnancy. 
There  is  also  a  variety  of  distressing  symptoms  produced 
by  pressure  on  the  larger  nerves,  especially  the  sciatic 
nerve,  as  pregnancy  advances ;  this  is  particularly  no- 
ticeable a  few  weeks  before  the  full  term,  although  it 
may  occur  at  any  period.  Those  who  swim  know  the 
disagreeable  sensation  caused  by  sudden  cramp  in  one  of 
the  limbs.  This  same  cramp,  to  a  greater  or  less  degree, 
may  come  on  while  the  patient  is  sitting  or  walking, 


PREGNANCY.  27 

and  be  productive  of  great  pain  ;  it  is  usually  felt  down 
the  back  of  the  thigh,  in  the  foot,  or  down  the  leg, 
especially  on  the  left  side  ;  this  is  greatly  relieved  by 
rubbing  with  chloroform  liniment,  but  the  most  rapid 
means  is  for  the  patient  to  assume  what  is  known  as 
the  knee  chest  position, — getting  on  her  knees  in  bed, 
with  her  head  on  the  pillow,  thus  throwing  the  weight 
of  the  child  forward.  The  greatest  relief  follows  this 
position,  if  taken  upon  retiring  at  night,  in  many  cases 
also  where  there  has  been  distressing  flatulence. 

A   FEW  WORDS   IJST   REGARD   TO   EXERCISE. 

It  is  scarcely  necessary  for  me  to  dwell  long  upon  the 
importance  of  exercise  in-  the  open  air  for  giving  an 
appetite,  in  fact,  for  the  maintenance  of  health ;  but 
just  how  much  exercise  to  take  is  often  a  difficult 
matter  for  one  to  determine.  The  muscles  should  be 
made  strong  and  healthy,  the  body  erect,  the  circulation 
free  in  all  parts  of  the  body,  and  at  the  same  time  the 
exercise  should  cease  before  the  sense  of  fatigue  is  so 
great  as  to  cause  prostration.  Then,  again,  the  exercise 
should  be  of  a  pleasant  nature ;  if  possible,  the  patient 
should  be  entertained ;  she  should  have  a  purpose  in 
view.  The  habit  of  strolling  listlessly  from  place  to 
place  simply  for  the  sake  of  fresh  air  falls  far  short  of 
giving  the  benefit  which  a  brisk  walk  or  a  healthy, 
pleasant  occupation  would  bring  about.  We  all  recog- 
nize this  fact,  and  we  all  know  the  healthy  individual 
is  the  one  who  is  occupied,  whether  the  occupation 
be  household  duties,  which  are  in  themselves  by  no 
means  devoid  of  active  exertion,  or  whether  it  be  the 
obligatory  hard  work  of  the  laboring  woman  whose 
robust  health  will  enable  her  to  bear  her  child  with 
ease  compared  with  the  labor  of  the  delicate,  weak- 
backed  girl  who  is  brought  up  in  the  lap  of  luxury 
with  every  wish  gratified,  with  every  muscle  unde- 
veloped, and  who  will  suffer  in  her  confinement  from 


28  MATERNITY. 

the  want  of  physical  force.  There  is  a  theory  at  the 
present  day,  which  is  a  most  interesting  one  and  prob- 
ably correct,  advocated  by  Darwin  and  his  disciples, 
that  excessive  development  of  the  intellect  from  the 
universal  higher  education  has  produced  and  is  still 
producing  a  relative  increase  in  the  size  of  the  heads  of 
the  children  of  intellectual  classes.  If  associated  with 
this  we  have  feeble  muscular  development  on  the  part 
of  the  girl,  what  else  can  we  expect  but  difficult  con- 
finements? And  undoubtedly  the  many  cases  of  serious 
womb-troubles  following  childbirth  are  due  to  these 
causes.  It  is  not  necessary,  then,  that  exercise  should 
mean  gymnastics  or  a  stated  walk  of  a  mile  each  day ; 
but  when  we  say  that  a  woman  while  she  is  carrying 
her  infant  should  use  her  muscles,  we  are  satisfied  that 
the  ordinary  exercise  which  falls  to  the  lot  of  the  house- 
keeper, especially  if  she  take  pride  in  the  appearance 
of  her  own  home,  will  be  sufficient,  together  with  the 
attention  to  those  duties  which  call  her  out  of  doors,  and 
give  her  all  the  fresh  air  and  muscular  development 
that  she  needs. 

In  the  earlier  stages  of  pregnancy, — and  by  early 
stages  we  mean  before  the  seventh  month, — there  is  very 
little  need  for  a  woman  to  change  her  habits  as  regards 
going  about;  if  she  keeps  perfectly  well,  walking  in 
moderation,  driving,  bathing  daily,  provided  it  is  not 
in  hot  water  or  water  that  is  too  cold.  As  regards 
dancing,  the  use  of  the  sewing-machine,  swimming, 
horse-back-riding,  these  questions  are  constantly  asked 
of  the  family  physician.  There  are  some  people  who 
will  immediately  take  the  ell  if  the  inch  is  granted, 
and  lay  all  the  blame  on  their  doctor ;  but,  as  it  is  his 
duty  to  understand  all  the  little  peculiarities  of  his  pa- 
tients, and,  indeed,  this  study  is  as  important  and  diffi- 
cult as  the  study  of  medicine  itself,  he  is  the  proper 
one  to  give  the  answers  in  each  individual  case.  My 
own  opinion  is  that  they  should  be  avoided ;  and  yet 


PREGNANCY.  29 

a  good  strong  healthy  woman  may  work  over  a  wash- 
tub  doing  the  hardest  kind  of  laboring  work  until  her 
term  is  up.  The  answer  to  this  is  that  if  the  young 
mother  who  reads  this  book  is  as  strong  as  this  woman 
who  has  been  brought  up  to  hardships,  she  probably 
could  do  the  same  thing. 

Should  our  patient  at  any  time  have  a  sense  of 
fatigue  after  exercise,  it  would  be  well  to  rest  before 
meals,  to  loosen  her  clothing  thoroughly,  to  lie  first  on 
one  side,  then  on  the  other,  to  relieve  the  pressure  which 
the  strain  of  walking  has  made  her  child  exert  upon 
the  large  blood-vessels  and  nerve-trunks. 

Indeed,  towards  the  latter  end  of  pregnancy,  after  her 
walk  she  will  find  a  recumbent  position  much  more 
comfortable  and  resting  than  a  sitting  one,  especially  if 
she  attempt  to  sit  in  a  comfortable  easy-chair  with  soft 
cushions.  It  is  very  rare  that  a  woman  cannot  take 
a  brisk  walk,  especially  in  the  evening  before  retiring  ; 
it  will  enable  her  to  get  a  good  night's  rest,  and  at  the 
same  time  she  will  feel  a  certain  amount  of  freedom  in 
going  out  at  this  hour  without  the  restraint  of  wearing 
close-fitting  clothes ;  and  this  leads  me  to  speak  of  the 
way  in  which  pregnant  women  should  dress. 

If  we  consider  the  subject  of  dress  we  shall  find  the 
object  to  be  gained  twofold, — first  warmth,  the  other 
fulfilling  the  dictates  of  fashion,  or,  in  other  words, 
personal  adornment.  The  matter  of  clothing  is  a  very 
important  one  at  this  time. 

Shortly  after  conception  takes  place  there  is  a  feeling 
of  weight,  which  is  usually  experienced  in  the  lower 
part  of  the  abdomen, — a  sense  of  fulness,  which  fre- 
quently gives  rise  to  discomfort  owing  to  the  sinking  in 
of  the  abdomen  from  enlargement  of  the  womb.  There 
may  be,  possibly,  a  dragging  weight  in  the  knees,  back- 
ache, constant  desire  to  urinate,  and  the  fulness  in  the 
bowel  which  accompanies  constipation.  By  the  third 
month  the  abdomen  will  increase  in  size,  and  will  grad- 


30  MATERNITY. 

ually  show  enlargement ;  as  we  have  before  noted,  the 
breasts  will  become  enlarged,  fuller.  Then  the  matter 
of  dress  becomes  one  for  further  consideration. 

It  should  be  definitely  borne  in  mind  that  at  no  one 
part  of  the  body  should  the  clothing  be  so  tight  as  to 
interfere  with  the  breathing  or  circulation ;  indeed,  there 
should  not  be  the  least  uncomfortable  pressure.  We 
may  set  this  down  as  a  rule  to  be  observed  in  all 
cases.  Physiologists  tell  us  that  women  breathe  more 
with  the  upper  part  of  their  chests  than  men,  and  that 
this  is  intended  by  nature  to  obviate  the  disadvantages 
which  would  otherwise  occur  during  pregnancy.  Should, 
then,  a  tight  band  be  placed  around  the  waist,  or  heavy 
skirts  hang  from  the  abdomen,  or  corsets  be  used  to  make 
the  wearer  look  small  and  not  show  her  condition,  in- 
terference with  breathing,  many  disorders  incidental  to 
pregnancy,  would  occur.  The  word  enceinte  itself  is 
derived  from  the  Latin,  which  signifies  that  the  Roman 
women  when  they  became  pregnant  divested  themselves 
of  the  girdle  which  was  always  worn  by  married  women. 
We  have  already  said  that  the  question  of  dress  was  one 
of  warmth  and  adornment.  As  far  as  warmth  is  con- 
cerned, there  is  no  doubt  that  the  accumulation  of  fat, 
which  is  greater  in  women  than  in  men,  permits  them 
to  wear  clothes  of  lighter  texture  than  the  opposite  sex. 
The  beauty  and  rotundity  of  form,  the  absence  of 
angles,  is  due  to  a  deposit  of  fat,  and  especially  is  this 
the  case  over  the  chest, — a  delicate  portion  of  the  body, 
where  exposure  carries  with  it  most  danger. 

In  this  latitude  of  40°  it  is  absolute  folly  for  women, 
especially  young  girls  and  those  about  reaching  the  meno- 
pause, or  change  of  life,  to  pass  our  winter  and  spring 
months  without  wearing  woollen  garments,  should  it 
only  be  the  lightest  gauze-flannel,  in  a  complete  set,  with 
high  neck  and  long  sleeves ;  in  fact,  the  argument  against 
it  is  that  an  evening-dress  necessitates  the  taking  off 
of  this  dress,  and  consequently  the  greater  exposure  to 


PREGNANCY.  31 

cold  in  consequence.  At  the  same  time  there  is  in 
reality  less  risk  to  be  run  in  a  heated  ball-room,  or 
when  the  individual  is  flushed  with  the  excitement  of 
pleasure,  than  when  exposed  to  the  dampness  of  the 
street,  with  nervous  depression,  in  a  cold  wind  or  bleak 
storm,  or  the  draughts  of  a  house  when  the  system  i? 
below  par  and  the  circulation  feeble.  All  pregnant 
women  should  most  certainly  wear  flannel  in  winter, 
or  they  can  use  the  more  expensive  materials  of  wool 
and  silk. 

There  is  a  fact  which  we  all  take  for  granted,  though 
the  fashion  fails  so  far  to  make  it  a  custom  in  this  pari 
of  the  world,  certainly  not  so  with  our  English  cousins, 
— that  all  articles  of  clothing  for  women  should  hang 
from  the  shoulder ;  that  is,  the  shoulders  should  bear 
the  weight.  In  England  the  fashion  is  rapidly  gaining 
ground  of  supporting  heavy  skirts  by  means  of  sus- 
penders ;  at  any  rate,  at  no  time  should  the  pregnant 
woman  have  any  article  of  clothing  which  will  constrict 
the  waist  or  drag  from  the  loins  or  hips.  This  should 
be  an  imperative  rule ;  and,  indeed,  when  we  come  to 
consider  the  question  of  dress  in  young,  growing  girls, 
we  will  see  why  it  is  that  heavy  skirts,  when  fastened 
around  the  waist,  are  productive  of  harm.  We  may 
say  that  there  are  actually  two  waists  in  all  women, — 
one  just  above  the  hip-bone  and  at  a  point  where  tight 
lacing  will  cause  pressure  on  all  organs  contained  in 
the  pelvis  (the  space  between  the  hip-bones) :  this  is 
the  smallest  part  of  the  body,  below  the  last  rib ;  the 
other  one  is  made  use  of  in  high-waisted,  old-fashioned 
dresses.  The  former  bears  the  weight  of  heavy  skirts 
that  are  belted  and  worn  without  corsets.  The  high- 
(short-)  waisted  dresses  are  certainly  less  harmful  than 
low-  (long-)  waisted  dresses.  This  leads  to  the  ques- 
tion of  corsets.  Our  own  opinion  is  that  a  light,  short 
corset  which  does  not  press  anywhere  unduly  is  of  great 
comfort  to  a  pregnant  woman ;  it  permits  the  skirts  and 


32  MATERNITY. 

undergarments  to  be  fastened  readily  without  compres- 
sion of  the  waist,  and  in  so  doing  distributes  the  weight 
very  much  as  if  the  garments  hung  from  the  shoulder. 
Moreover,  it  gives  support  to  the  back,  which  is  fre- 
quently restful,  especially  when  the  weight  of  the  child 
becomes  excessive,  and  when  the  small  of  the  back  suffers 
great  strain  from  fatigue.  It  will  also  give  warmth  to 
the  body, — that  is  to  say,  an  even  temperature,  espec- 
ially around  the  abdomen. 

THE  CARE  OF  THE   BREASTS   DEMANDS   ATTENTION. 

From  the  very  first  month  we  have  seen  that  the 
breasts  take  upon  themselves  certain  changes ;  they  be- 
come larger,  become  tender,  and  are  apt  to  contain,  as 
time  goes  on,  a  small  quantity  of  milk.  The  stretching 
of  the  skin  from  this  enlargement,  as  also  the  stretching 
of  the  skin  of  the  abdomen,  causes  a  great  deal  of  dis- 
comfort. The  clothes  should  be  made  to  fit  closely  with- 
out undue  pressure.  When  the  tension  and  feeling  of 
fulness  in  the  breasts  and  abdomen  becomes  intense,  it  can 
be  relieved  by  anointing  the  skin  thoroughly  at  night 
before  retiring  with  vaseline,  sweet  oil,  cocoa-butter,  or 
almond  oil.  Great  attention  from  the  first  should  be 
paid  to  the  nipple,  owing  to  the  fact  that  in  most  cases 
abscesses  of  the  breast  are  frequently  caused  by  an  abra- 
sion or  crack  in  a  tender  nipple ;  and  indeed  at  many 
times  a  depression  or  sinking  in  of  the  nipple  will  pre- 
vent the  mother  from  nursing  her  child,  which  could 
be  obviated  by  attention  during  pregnancy.  It  is  well 
known  that  the  nipple  should  stand  out  prominently 
in  the  centre  of  the  breast  without  any  indentation  or 
gutter  around  it  whatever.  By  gradually  accustoming 
herself  to  it  she  will  be  enabled  to  manipulate  it  with- 
out the  least  feeling  of  tenderness.  It  should  be 
sponged  every  morning  and  gently  dried  with  a  mod- 
erate amount  of  friction.  If  the  nipple  sinks  to  the  level 
of  the  breast  or  below  it,  it  should  be  pulled  out,  which 


PREGNANCY.  33 

can  be  readily  done  either  by  suction  or  wearing  glasses 
made  for  that  purpose,  which  can  be  procured  at  any 
drug-store ;  they  are  simply  glass  disks  with  a  hole  in 
the  middle.  In  our  opinion  it  is  a  great  mistake  to  use 
brandy  or  any  drying  subject  to  harden  the  skin,  unless 
ordered  by  the  physician.  The  small  glands  which  sur- 
round the  nipple  and  are  prominent  in  the  dark  areola 
or  ring  are  lubricating  glands,  and  these  prevent  soften- 
ing or  excoriation,  cracks  or  fissures,  which  will  event- 
ually produce  abscesses.  Drying  substances  check  the 
action  of  the  glands  and  produce  chapped,  hardened 
tissues,  which  easily  crack. 

As  regards  the  effect  of  emotions  and  the  result  of 
maternal  impressions,  from  time  immemorial  it  has  been 
known  that  the  closest  relationship  through  nervous  in- 
fluence exists  between  the  mother  and  her  unborn  child. 
To  quote  from  Parvin,  the  following  directions  were 
laid  down  by  one  of  the  medical  writers  of  India  four- 
teen hundred  years  B.C.  : 

"  The  pregnant  woman  shall  avoid  becoming  weary, 
.  .  .  sleeping  in  the  daytime,  watching  at  night,  sorrow, 
climbing  into  a  wagon,  sitting  upright,  violent  move- 
ments, .  .  .  and  long-continued  exertion.  From  the 
first  day  she  must  be  cheerful,  pious,  and  clean  in  cloth- 
ing and  person.  .  .  .  She  must  avoid  getting  angry, 
carrying  loads,  or  talking  too  loud." 

The  ancients,  especially  among  the  Greeks,  sur- 
rounded their  women  during  this  period  with  all  that 
was  beautiful  in  art,  that  their  sons  might  become 
strong  and  muscular  and  their  daughters  graceful. 
Undoubtedly  there  have  been  noted  cases  wherein  ma- 
ternal impressions  affected  the  offspring,  but  far  more 
frequently  have  been  the  cases  where  the  fear  of  some 
such  result  has  made  the  mother  brood  over  sights 
which  she  has  witnessed  until  a  passing  impression  has 
indelibly  fixed  itself  upon  her  nervous  system  and  af- 
fected the  nutrition  of  her  child.     A  woman  should 


34  MATERNITY. 

avoid  all  emotions,  should  lead  a  life  as  placid  as  the 
most  devout  follower  of  Buddha,  should  use  moderation 
in  all  things,  and  if  perchance  in  the  ordinary  course 
of  her  daily  avocations,  or  in  the  bustle  and  turmoil  of 
a  large  city,  unpleasant  sights,  narrations,  or  thoughts 
make  impressions  upon  her,  she  should  cast  them  aside 
as  unworthy  of  consideration,  and  believe  with  the  ma- 
jority of  the  medical  profession  of  the  present  day  that 
her  child  will  be  uninfluenced  by  them.  I  cannot  do 
better  than  quote  a  recent  extract  from  The  Fortnightly : 

"  The  ideal  mother  is  undoubtedly  a  woman  more 
placid  than  nervous  in  temperament,  more  energetic 
than  restless  in  habits,  and  with  more  strength  of  char- 
acter and  general  good  sense  than  specialized  intellec- 
tual acquirements.  Strong  emotions,  strained  nerves, 
excitement,  anxiety,  absorption,  are  all  hurtful  to  the 
unborn  child.  They  tend  to  bring  on  premature  birth; 
and  if  not  this,  then  they  create  sickly  offspring,  whom 
the  mother  cannot  nourish  when  they  are  born." 

I  will  complete  this  chapter  by  giving  a  list  of  the 
things  which  should  be  provided  for  an  ordinary  case 
of  confinement.  Of  course  as  much  more  can  be  added 
as  the  social  position  or  wealth  of  the  family  may  re- 
quire.    What  I  give  here  are  merely  the  necessities  : 

BASKET. 

Brush  and  comb. 

Skein  of  white  twisted  embroidery-silk. 

Soft  fine  sponge. 

Bottle  of  white  vaseline. 

Sharp  pair  of  pointed  scissors. 

Powder-box  and  puff,  with  talc-powder. 

Pincushion. 

Small  and  large  safety-pins. 

Pure  Castile  soap. 

Pair  of  socks. 

Some  old  fine  linen. 


PREGNANCY.  35 

Flannel  or  knitted  band. 

Flannel  shirt,  a  petticoat  and  night-gown  for  infant. 

An  afghan,  or  piece  of  extra  flannel,  in  which  to  wrap 
child. 

Also  piece  of  flannel,  or  old  blanket,  to  receive  it  in. 

In  addition  the  baby  will  require  eight  day  dresses, 
eight  night-gowns,  eight  white  skirts,  four  day  flannel 
skirts,  four  night  flannel  skirts,  four  pairs  of  day  socks, 
four  pairs  of  night  socks,  six  flannel  shirts,  six  flannel 
bands,  three  dozen  small  soft  linen  diapers,  three  dozen 
larger  cotton  ones,  at  least  two  little  knitted  sacques. 

The  mother  will  require  for  herself — 

One  gum  blanket  two  yards  square. 

One  comfortable,  and  in  addition  to  this  an  old  one 
had  better  be  at  hand. 

Some  old  cotton  sheets. 

A  Davidson  syringe. 

A  bed-pan. 

A  couple  of  binders  made  of  well-washed  unbleached 
muslin,  not  too  coarse,  wide  enough  to  extend  from 
the  ribs  to  below  the  hips.  In  winter  these  can  be 
made  out  of  baby-flannel. 

A  supply  of  old  towels  or  old  sheets,  to  be  thoroughly 
washed  and  packed  away  until  required. 

A  glass  tube  for  taking  medicine. 

Also  some  prepared  absorbent  cotton  ;  the  sublimated 
or  borated  is  the  best. 

The  use  of  the  binder  at  the  present  day  is  not  in- 
sisted upon  by  most  accoucheurs,  but  its  object  is  to 
give  warmth  and  gentle  support;  that  used  for  the  child 
is  for  the  same  purpose,  therefore  if  it  is  too  tight  it  does 
far  more  harm  than  good,  and  had  better  be  abandoned 
altogether.  It  certainly  does  help  the  overstretched 
muscles  to  regain  their  tonicity,  and  undoubtedly  in 
this  way  allows  the  figure  to  resume  its  normal  propor- 
tions. 

A  few  words  to  the  monthly  nurse. 


36  MATERNITY. 

Your  position  is  one  of  great  responsibility,  as  fre- 
quently emergencies  will  arise  that  will  tax  your  in- 
genuity and  knowledge  to  the  utmost.  You  do  not 
degrade  yourself  by  attending  thoroughly  to  every  de- 
tail that  will  add  to  the  comfort  of  your  patient  and 
the  maintenance  of  the  equilibrium  of  the  household 
during  this  trying  period.  You  should  be  neat,  in- 
terested in  your  case,  guarded  in  your  conversation,  ready 
and  willing  to  wait  upon  yourself,  affable  to  all,  have 
tact  and  dignity  in  your  dealings  with  those  with  whom 
you  are  obliged  to  come  in  contact.  Do  not  under  any 
circumstances  narrate  the  histories  of  other  cases  you 
have  nursed,  or  enter  into  the  discussion  of  private 
family  affairs  and  scandals. 

Take  your  patient  thoroughly  under  your  charge, 
and  do  everything  for  her  comfort  both  of  mind  and 
body.  When  the  patient  is  in  bed,  after  confinement, 
under  no  circumstances  allow  her  to  be  in  a  draught. 
If  you  open  the  window  for  a  moment  to  ventilate  or 
dust,  always  cover  your  patient  and  close  the  doors. 

When  you  sponge  her,  surround  the  parts  with  a  dry 
towel,  so  as  not  to  wet  the  sheets,  and  only  sponge  one 
part  at  a  time,  then  dry  thoroughly,  and  do  not  use 
damp  towels. 

In  a  work  of  this  kind  it  is  well  to  give  some 
advice  upon  miscarriage.  By  this  we  mean  a  prema- 
ture birth,  though  in  strictly  medical  language  this 
name  is  applied  only  to  that  which  occurs  after  quick- 
ening. There  are  many  things  which  prevent  the  full 
time  of  pregnancy.  Some  of  these  are  due  to  disease 
of  the  unborn  child,  which  causes  its  early  death ; 
others  to  disease  of  the  mother,  which  prevents  the 
womb  from  enlarging  beyond  a  certain  point,  or  fevers, 
or  severe  illnesses;  and  others,  again,  are  due  to  ac- 
cidents. Frequently  carelessness  on  the  part  of  the 
mother,  over-fatigue  in  her  household  duties  or  social 
requirements,  ill-fitting  clothing,  obstinate  constipation, 


PREGNANCY.  37 

unduly  long  walks,  heavy  lifting,  or  any  strain  or  ex- 
citement. At  times  there  seems  to  be  a  certain  fatality 
wliich  prevents  mothers  from  carrying  their  children  to 
full  term.  A  woman  will  conceive,  everything  will  go 
on  well  till  the  third  or  fourth  month,  and  then  mis- 
carry ;  a  sort  of  habit  will  be  established,  and  she 
will  do  this  for  several  times  in  succession.  Her  womb 
needs  a  rest,  it  has  become  irritable ;  and  if  this  physio- 
logical rest  is  given  it  and  she  again  conceives,  she  will 
go  on  to  full  term. 

The  earliest  symptom  of  miscarriage  is  usually  the 
appearance  of  a  flow.  If,  then,  immediate  rest  in  bed 
be  enforced, — and  this  rest  in  bed  is  absolutely  necessary, 
— and  proper  medical  treatment  is  instituted,  it  may  be 
checked.  The  patient  should  at  once  go  to  bed,  remain 
absolutely  quiet,  and  send  for  her  physician.  Even 
after  the  flow  has  been  established  the  child's  life  may 
be  saved. 

Miscarriages  are  by  no  means  as  simple  and  harmless 
things  as  some  women  try  to  impress  upon  themselves 
that  they  are.  Many  of  the  diseases  of  the  womb, 
which  entail  a  long  course  of  medical  treatment  and 
give  rise  to  permanent  ill  health,  date  from  this  cause, 
which  a  little  care  would  have  avoided. 

Many  cases  of  miscarriage  in  early  married  life 
are  undoubtedly  due  to  the  fact  that  these  young  mar- 
ried women  endeavor  to  conceal  their  condition  from 
their  friends;  and,  instead  of  adapting  their  life  as 
they  should  to  their  changed  state,  they  thoughtlessly 
join  in  the  amusements  and  fatigues  of  society,  dress 
as  is  most  becoming  to  them,  and  conceal  the  annoyance 
and  suffering  which  this  often  entails. 


PART    II. 

INFANCY. 


CHAPTER   II. 

CAEE   OF   NEW-BOKN  INFANT. 

How  to  cleanse  a  New-born  Babe — -The  Cord,  and  the  Care  which 
it  should  receive — The  Binder  and  its  Object — Importance  of 
noting  the  Child's  Secretions — A  Babe  should  be  given  "Water 
occasionally — All  about  the  Mother's  Milk  first  making  its  Ap- 
pearance— The  Diet  of  the  Nursing  Mother — How  to  check  an 
excessive  flow  of  Milk,  and  to  increase  an  Insufficient  Supply — 
The  Child's  Diet — How  often  a  Child  should  receive  Nourish- 
ment. 

It  is  scarcely  necessary  for  me  to  dwell  very  long  on 
the  care  of  the  infant  immediately  after  its  birth ;  that 
matter  devolves  entirely  upon  the  doctor  and  the  nurse. 
But  there  are  a  great  many  things  that  a  mother  should 
know  about  her  infant,  and  these  I  will  endeavor  to 
explain  as  simply  as  possible.  The  child  at  birth  is 
covered  with  a  waxy  material,  differing  more  or  less  in 
amount  in  different  cases.  It  is  said  that  in  children 
who  have  very  delicate  skins  the  amount  of  this  ma- 
terial is  often  greater  than  otherwise.  As  it  occupies 
every  portion  of  the  body,  and  can  be  removed  by 
greasing  the  surface,  the  new-born  child  should  be 
thoroughly  anointed  with  either  washed  lard  or  vase- 
line, and  then,  with  a  soft  sponge,  tepid  water,  and  a 
little  Castile  soap,  given  a  superficial  cleansing  to  re- 
move as  much  as  possible  of  the  material.  The  eyes, 
mouth,  ears,  and  nostrils,  in  fact,  all  of  the  mucous 
38 


CARE   OF  NEW-BORN  INFANT.  39 

surfaces,  should  be  carefully  washed  with  warm  water 
and  a  clean  sponge  or  piece  of  old  linen.     This  should 
be  done  after  the  cord  has  been  severed.     The  cord, 
which  is  the  attachment  between   the  child  and  the 
after-birth,  contains  the  blood-vessels  embedded  in  a 
gelatinous  material  more  or  less  thick.      As  soon  as 
the  child  is  born  and  takes  its  first  breath,  the  circu- 
lation in  the  blood-vessels  of  the  cord  gradually  ceases. 
It  is  not  at  all  necessary  that  the  cord  of  the  child 
should  be  cut  immediately  after  birth,  nor  should  it  be 
done  until  breathing  has  been  fully  established.     The 
cord  is  usually  grasped  by  the  hands,  and  the  jelly-like 
material  within  it  squeezed  with  the  fingers  towards  the 
mother ;  in  this  way  compression  of  the  blood-vessels 
takes  place.    A  ligature  is  placed  tightly  about  it,  about 
three  inches  from  the  child's  surface,  and  another  one 
about  three  inches  from  that  towards  the  maternal  parts  ; 
it  is  then  cut  with  scissors  between  the  two.     After 
the  child  has  received  its  first  washing  the  navel-string 
should  be  enveloped  in  a  mass  of  the  sublimated  absorb- 
ent cotton,  folded  up  in  a  piece  of  linen,  laid  to  one  side, 
and  then  the  child's  binder  placed  about  it.    The  object 
of  this  binder  is  simply  to  give  warmth,  and  support 
the  cord.     Undoubtedly,  if  the  navel-string  were  al- 
lowed to  hang,  be  caught  in  the  clothing,  be  pulled 
about  as  the  child  receives  its  daily  washing,  a  rupture 
might  take  place.     I  think  undue  stress  has  been  laid 
upon  the  value  of  a  binder  to  prevent  rupture,  and  not 
half  sufficient   importance  given   to  the   binder  as  a 
protector  in  our  changeable,  treacherous  climate.    While 
the  child  is  being  washed  and  dressed  it  is  well  to  secure 
deep  and  full  respirations.    It  is  said  that  a  crying  child 
at  birth  has  stronger  lungs  afterwards.     If  it  is  turned 
over  on  its  stomach  with  head  lower  than  the  rest  of 
its  body  during  process  of  washing,  the  mucus  will  not 
be  drawn  in  during  its  inspiration,  and  a  healthy  infla- 
tion of  the  lungs  will  take  place.     As  soon  as  possible 


40  INFANCY 

the  mother  and  child  should  get  some  sleep.  After 
several  hours'  sleep  the  child  can  be  again  washed,  if 
necessary,  or  sponged  off;  and  this  time  it  should  be 
much  more  thoroughly  done.  The  circulation  will  be 
more  thoroughly  established,  and  the  skin  will  assume 
the  delicate,  soft  red  appearance  of  health.  Extended 
experience  has  convinced  me  that  for  the  first  few  days 
a  little  vaseline  or  cocoa-butter  is  better  to  use  on  the 
child  after  its  bath  than  the  dry  powders  heretofore  in 
vogue.  It  needs  but  very  slight  greasing  of  the  surface 
to  make  the  skin  soft  and  pliable  and  to  prevent  erup- 
tions. 

The  child's  clothing  should  have  two  important 
qualifications :  it  should  be  warm,  and  absolutely  loose 
in  all  parts  of  the  body. 

After  the  child  has  had  its  first  nap,  attention  should 
be  paid  to  its  secretions.  If  the  bowels  have  been  moved, 
use  vaseline  instead  of  water  for  its  washing ;  if  it  has 
not  passed  its  water,  call  the  doctor's  attention  to  it  at 
his  next  visit :  this  is  an  important  matter.  It  will  be 
noted  that  the  navel-string  will  come  away  in  four  or 
five  days  without  any  offensive  odor  whatsoever.  This 
method  of  dressing  the  cord  is  a  convenient  one,  as  it 
does  not  require  to  be  touched  after  its  first  arrangement. 
The  use  of  the  ligature  is  simply  a  matter  of  precaution, 
it  is  not  a  matter  of  necessity. 

As  a  rule  there  is  very  little  trouble  from  the  navel, 
though  possibly  at  times,  if  the  child  should  become 
constipated,  or  have  a  severe  cough,  great  straining  may 
take  place,  when  bulging  or  rupture  ensues.  This  can 
be  readily  obviated  by  placing  a  small  pad  beneath  the 
binder,  not  exerting  great  pressure ;  indeed,  a  binder 
which  is  too  tight  is  more  apt  to  cause  a  rupture  than 
none  at  all.  Should  there  be  any  discharge  from  the 
navel,  the  nurse  should  make  a  careful  examination  of 
it  when  the  child  is  being  washed,  and  if  a  small  ulcer- 
ation is  found,  as   is   sometimes  the  case,  it  can  be 


CARE   OF  NEW-BORN  INFANT.  41 

touched  with  Milestone  and  then  dressed  with  benzoated 
oxide  of  zinc  ointment.  It  makes  very  little  difference 
on  which  side  the  child  lies  after  its  birth.  It  is  scarcely 
necessary  to  dwell  to  any  great  length  upon  the  appear- 
ance of  a  healthy  child  at  its  birth.  The  soft,  peach- 
like character  of  its  skin,  the  constant  tendency  to  sleep, 
which  is  uninterrupted  and  quiet,  associated  with  an  air 
of  repose,  are  well-known  evidences  of  health.  It  is 
not  necessary  to  dwell  at  length  on  the  fact  that  the 
child  at  this  age  is  a  noted  creature  of  habit ;  indeed,  as 
we  come  to  consider  infants  as  they  grow,  and  we  study 
the  many  causes  for  that  most  distressing  state  of  affairs, 
sleeplessness,  we  can  trace  it  back,  I  can  almost  say  in 
one -half  of  the  cases,  to  the  unfortunate  indiscretion  in 
humoring;  the  child  when  it  is  not  more  than  a  few 
weeks  old.  The  young  mother  feels  that  the  cry  of 
her  child  must  naturally  come  from  hunger ;  but  as 
nature  has  failed  to  supply  material  for  the  fountain, 
she  is  often  indiscreetly  advised  to  substitute  milk  and 
water,  a  little  catnip  tea,  or  Mellin's  food.  My  own 
experience  teaches  me  that  this  is  wrong,  and  that  the  \ 
following  procedure  is  the  one  to  be  recommended.  ■■ 
After  the  mother  has  rested  thoroughly  the  child  should 
be  placed  to  her  breast.  Some  children  will  immediately  i 
proceed  to  work,  knowing  exactly  what  they  have  to  do;  \ 
others  again  may  refuse  absolutely  to  nurse.  Those  that 
seem  to  know  all  about  it  will  find  it  hard  at  first  to 
obtain  any  nourishment.  After  many  attempts,  and  suc- 
ceeding only  in  extracting  what  is  known  as  colostrum, 
a  laxative  secretion  which  precedes  the  milk-flow,  they 
will  from  sheer  exhaustion  give  up  the  attempt  and  fall 
asleep.  The  infants  that  refuse  the  breast  cry  and  fret. 
To  these  it  may  be  well  to  give  a  linen  rag  moistened 
in  water  to  suck,  or  a  little  water  with  a  spoon,  and 
then  at  a  regular  definite  interval,  say  an  hour,  place 
them  once  more  to  the  breast  until  they  become  used  to 
it.     There  is  no  danger,  under  any  circumstances,  of  a 

4* 


42  INFANCY. 

child  starving  to  death  for  several  hours,  at  least :  it 
can  exist  without  food,  and  needs  only  a  little  water ; 
and  then,  if  it  is  placed  during  the  next  twenty-four 
hours  in  daytime  every  hour  to  the  breast,  and  after 
that  regularly  every  two  hours,  by  the  time  the  flow  of 
milk  is  thoroughly  established  the  child  will  have  its 
little  programme  laid  down  for  it,  from  which  it  must 
not  deviate  under  any  circumstances.  If  it  becomes 
absolutely  necessary  to  feed  the  child,  condensed  milk, 
one  teaspoonful  to  twelve  or  fifteen  of  water,  is  to  be 
preferred.  For  about  two  or  three  weeks  the  child 
should  be  nursed  every  two  hours  day  and  night,  and 
during  the  periods  of  intermission  both  the  mother  and 
child  should  sleep  as  much  as  possible.  It  is  understood 
that  the  child  should  nurse  at  each  breast  alternately. 
This  is  an  important  matter,  because  a  child  would  soon 
get  accustomed  to  one  breast  and  refuse  the  other,  and 
this  leads  to  incalculable  suffering.  After  the  child  is 
nursed  the  nipple  should  be  washed  with  a  little  plain 
water  or  soda  or  borax  and  water  and  greased  with  some 
vaseline. 

The  flow  of  milk  generally  begins  on  the  third  day. 
The  flow  may  come  on  suddenly.  There  seems  to  be  a 
rush  of  milk  to  the  breasts.  Indeed,  this  is  usually 
the  way  the  milk  comes  at  each  nursing.  The  woman 
frequently  will  have  no  evidence  of  milk  whatever, 
the  breasts  hanging  flabby  and  long,  when,  at  the  hour 
at  which  her  child  usually  nurses,  or  even  at  emotion 
or  thought  of  her  child  alone,  the  flow  of  milk  will 
take  place.  This  is  especially  the  case  with  those  who 
have  had  children  before.  These  women  sometimes 
make  the  very  best  wet-nurses. 

The  diet  of  a  mother  after  childbirth  usually  con- 
sists of  ordinary  sick-diet.  The  object  of  keeping  a 
woman  on  diet  of  this  kind  is  simply  because  she  is  in 
bed,  her  digestive  system  is  rather  weakened  by  the 
excessive  strain,  mental  and  otherwise,  which  she  has 


CARE   OF  NEW-BORN  INFANT.  43 

gone  through,  with  fatigue,  and  liquid  nourishment  can 
be  given,  which  is  more  readily  digested  and  quickly 
absorbed  than  solid  food.  Doctors  simply  differ  in  their 
advice  because  patients  differ  in  regard  to  their  digestion. 
Sometimes  a  woman  is  ordered  a  mutton-chop,  a  bowl 
of  thick  gruel,  or  some  milk-toast  immediately  after  a 
confinement;  others,  again,  are  allowed  to  get  up  before 
the  ninth  day.  The  family  physician  knows  the  pecu- 
liarities of  his  case,  and  is  capable  of  judging  what 
is  best  for  his  patient.  Strong,  healthy  women  can 
do  many  things  that  the  frail  and  delicate  cannot 
attempt.  As  the  supply  of  milk  contains  so  large 
a  quantity  of  water,  almost  ninety  parts  in  a  hundred, 
a  great  deal  of  the  food  which  the  mother  takes 
should  be  liquid  to  supply  this  demand.  If  a  mother 
loses  her  baby  in  childbirth,  and  it  is  necessary  to 
check  the  flow  of  milk,  not  only  is  it  customary  to  put 
belladonna-plasters  on  the  breasts,  but  also  to  diminish 
the  amount  of  fluid  taken.  If  she  wishes  to  increase 
the  flow  of  milk,  she  can  drink  freely  of  milk,  soups, 
water,  also  rub  the  breasts  on  the  outside  with  some 
castor  oil.  It  is  probable  in  this  way  the  use  of  alco- 
holic stimulants,  as  beer  and  porter  in  large  amounts, 
became  fashionable  for  the  purpose  of  increasing  the 
milk-supply.  Though  excellent  at  times  for  delicate, 
worn-out  women,  I  certainly  would  oppose  their  uni- 
versal use.  I  think  the  alcohol  rather  lessens  the  milk- 
flow.  The  preparations  of  malt  are  far  more  valuable, 
as  they  increase  the  appetite  and  aid  digestion. 

There  being  what  is  known  as  a  determination  of 
blood  to  the  mammary  glands  during  the  secretion  of 
milk,  many  substances  may  be  carried  along  with  it 
that  should  be  thrown  off  in  other  ways;  thus  medicines 
are  often  secreted  by  the  milk,  and  affect  the  child, 
that  are  intended  to  have  a  purgative  action  on  the 
mother ;  a  dose  of  castor  oil  will  act  sometimes  in  this 
way.     Articles  of  diet  also  affect  milk.     We  are  all 


44  INFANCY. 

familiar  with  the  garlic  taste  given  to  milk  and  retained 
in  the  butter,  from  cows  turned  out  to  grass  in  the  spring- 
time. And,  indeed,  cases  have  occurred  of  acute  poison- 
ing by  milk  from  cows  that  have  eaten  largely  of  poi- 
sonous herbs  in  the  pasture- field.  Although  a  mixed 
diet,  containing  a  free  supply  of  vegetable  food,  also 
of  animal  food,  of  the  cereals,  together  with  a  proper 
amount  of  fluid,  is  important  for  every  nursing  mother, 
there  are  certain  times  when  additions  should  be  made 
to  one  of  these  divisions  of  food  to  supply  a  demand ; 
thus,  if  a  child  is  emaciating,  does  not  seem  to  in- 
crease in  weight,  the  free  use  of  fats  by  the  mother,  as 
cod-liver  oil,  will  soon  show  an  improvement.  If  there 
is  a  tendency  to  rickets,  the  mother  should  eat  more 
largely  of  preparations  containing  lime,  such  as  oat- 
meal, cracked  wheat,  or  even  take  lime  itself.  A 
woman  who  is  fat  and  well  nourished  may  have  the 
poorest  kind  of  milk  for  her  baby;  all  the  nourishment 
goes  to  herself,  the  milk  probably  being  of  a  very  thin, 
watery  kind.  Indeed,  in  the  choice  of  a  wet-nurse  it 
is  often  found  that  the  lean,  healthy  woman  gives  the 
most  and  the  best  milk. 

Constipation  resulting  from  torpidity  of  the  liver,  or 
over-feeding,  will  frequently  affect  the  milk  and  cause  it 
to  disagree  with  the  child.  Not  alone  is  milk  altered 
in  its  nourishing  qualities,  or  in  its  digestibility,  by 
materials  not  belonging  to  it  or  entering  into  its  com- 
position, but  we  very  frequently  have  indigestion  pro- 
duced by  milk  which  has  probably  been  changed  in  its 
characteristics  by  emotion,  by  strong  nervous  impressions 
due  to  worriment,  fright,  or  the  engagements  of  society  ; 
certainly  late  dinner-parties,  both  from  the  character  of 
the  food  and  the  late  hour,  would  not  be  conducive  to 
the  production  of  nourishing  milk.  We  have  stated  that 
regularity  is  the  fundamental  law  to  be  observed  by  the 
nursing  mother.  Her  food  should  be  most  plentiful, 
palatable,  of  the   most   nourishing   quality,  and   fre- 


CARE   OF  NEW-BORN  INFANT.  45 

quently  taken.  Bread,  butter,  and  milk  should  be 
used  in  large  amounts.  A  cup  of  hot  coffee,  or  chocolate, 
in  the  morning  before  rising ;  a  substantial  breakfast ; 
the  heaviest  meal  in  the  middle  of  the  day ;  a  light  tea 
in  the  evening,  with  a  bowl  of  gruel,  such  as  oatmeal, 
the  last  thing  upon  retiring ;  a  glass  of  milk  just  before 
or  after  each  nursing,  and  possibly,  if  the  patient  feels 
much  exhausted,  malt  extract  will  be  of  service. 

We  will  repeat  the  same  directions  in  regard  to  the 
bowels  as  are  found  in  a  previous  chapter.  It  is  neces- 
sary that  they  should  be  daily  moved ;  this  may  be 
accomplished  by  a  free  vegetable  diet,  the  moderate  use 
of  fruits,  exercise  in  the  open  air,  and  an  occasional 
enema  if  required.  The  use  of  purgatives  should,  be 
confined  to  cascara  cordial,  compound  liquorice  powder, 
a  teaspoonful  at  night,  Husband's  magnesia,  or  effer- 
vescing citrate.  Great  care  should  be  taken  by  the 
mother  that  she  does  not  take  cold.  It  is  well  to  have 
always  a  light  shawl  to  throw  over  her  while  nursing 
her  baby.  Let  me  say  a  few  words  in  regard  to  wet- 
nurses. 

WET-NURSES. 

It  sometimes,  as  we  all  know,  becomes  necessary  to 
decide  on  very  short  notice  on  the  question  of  having 
a  wet-nurse.  I  will  not  go  deeply  into  this  matter,  be- 
cause the  circumstances  of  each  case  so  group  them- 
selves as  to  bring  the  answer  without  consulting  a  book. 
The  age  of  the  child,  the  financial  condition  of  the 
family,  residence,  are  all  to  be  taken  into  consideration. 
The  wet-nurse  should,  if  it  is  possible,  have  had  other 
children ;  her  child  should  be  about  the  age  of  the  one  she 
is  to  nurse ;  she  should  be  a  perfectly  healthy  woman ;  her 
child  should  also  be  seen,  thoroughly  examined,  and 
give  all  the  evidences  of  perfect  health.  First  of  all  the 
family  record  should  be  investigated.  Did  her  father, 
mother,  sisters,  or  brothers  die  of  consumption,  cancer, 


46  INFANCY. 

scrofula  ?  If  she  has  had  other  children,  were  they 
strong  and  healthy  ?  Did  they  thrive  upon  her  milk  ? 
If  they  died,  of  what  did  they  die  ?  The  physical  con- 
dition of  the  wet-nurse  is  as  important,  of  course,  as  her 
family  record.  She  should  have  no  constitutional  dis- 
ease of  any  kind ;  her  lungs  should  be  healthy ;  her 
skin  should  be  clean,  free  from  any  eruption,  or  the  re- 
mains of  one;  her  teeth  should  be  good,  which  is  an 
evidence  of  good  digestion  ;  her  eyes  bright,  her  mus- 
cles firm  and  well  formed  ;  she  should  have  no  loss  of 
hair,  sore  throat,  or  chronic  nasal  catarrh  ;  her  breasts 
should  be  well  formed  and  such  as  I  have  described  on 
page  32.  She  should  not  menstruate.  C  Then  comes  the 
question  of  temper,  and  indeed  it  is  as  hard  here  to  get 
a  satisfactory  testimony  as  it  was  for  the  physical  condi- 
tion. She  should  be  pleasant  in  disposition,  not  stupid  ; 
energetic,  willing,  devoid  of  high  temper,  and  possessed 
of  those  traits  which  will  soon  endear  the  child  to  her.. 
Such  a  nurse  would  probably  give  about  two  quarts 
of  milk  in  twenty-four  hours.  Of  course,  much  of 
this  examination  is  made  by  the  family  physician,  who 
is  the  one  to  decide  whether  the  nurse  is  suitable  or  not, 
but  there  are  times  when  the  mother,  or  monthly  nurse, 
has  to  decide  in  cases  of  emergency.  On  that  account 
I  have  dwelt  at  some  length  on  this  subject.  The 
nurse's  child  should  be  plump,  well  formed,  free  from 
any  eruption.  Its  odor  should  be  sweet  and  fresh,  not 
sour ;  should  it  vomit,  the  material  should  be  simply 
the  overloading  of  the  stomach  and  not  sour  milk.  A 
healthy  baby  will  often  take  more  than  its  stomach 
will  hold,  especially  if  the  mother's  milk  is  plentiful 
and  flows  freely. 

Having,  then,  decided  upon  the  health  of  the  wet- 
nurse  and  on  the  chances  that  her  milk  will  be 
plentiful,  she  should  be  questioned  carefully  about  her 
supply  of  milk.  Indeed,  the  condition  of  her  own 
baby  will  be  evidence  in  itself.     There  are  other  matters 


CARE   OF  NEW-BORN  INFANT.  47 

to  be  taken  into  consideration.  The  nurse's  child  will 
have  to  be  taken  by  some  one  who  will  give  it  care, 
so  that  her  mind  may  be  entirely  relieved  on  that  score, 
as  anxiety  and  fretting  may  cause  her  to  lose  all  her 
milk  in  a  short  time.  It  must  be  remembered  that  she 
comes  from  a  class  who,  as  a  rule,  are  accustomed  to 
much  out-door  life,  very  plain  diet,  and  regular  habits, 
and  that  a  sudden  change  to  a  life  which  is  luxury, 
variety  in  cooking,  over-stimulating  food,  is  apt  to 
bring  about  a  condition  of  biliousness,  laziness,  irrita- 
bility of  temper,  which  is  difficult  indeed  to  regulate. 
I  have  frequently  known  of  the  very  best  of  wet-nurses, 
who  have  given  satisfaction  for  a  month  or  so,  sud- 
denly without  any  apparent  cause  lose  all  their  milk, 
and  the  whole  trouble  of  selection  and  the  risk  of  get- 
ting a  milk  which  does  not  agree  with  the  child  has  to 
be  gone  over.  Indeed,  if  under  such  circumstances 
the  woman  proves  herself  to  be  reliable  and  affectionate, 
it  is  often  far  better  to  put  the  child  upon  the  bottle 
and  keep  her  as  ordinary  nurse.  When  the  question 
comes  up  for  a  decision  between  a  wet-nurse  and  bottle- 
feeding,  we  should  bear  in  mind  that  the  child  who  is 
to  be  subject  to  city  influences  should  be  wet-nursed, 
especially  during  the  hot  summer  months.  I  believe 
that  bottle-feeding,  which,  as  we  shall  see  farther  on, 
requires  the  greatest  amount  of  care  and  watchful- 
ness, is  successful  in  many  cases,  but  the  more  I  see 
of  it  the  more  satisfied  I  am  that  every  child  should 
receive  breast-milk  until  it  is  four  months  old  ;  at  least 
this  is  imperative  for  a  city  child.  Of  course  when  a 
child  is  delicate,  or  where  there  is  an  inherited  taint  in 
the  family,  such  as  consumption,  or  the  family  is  known 
as  a  delicate  one,  wet-nursing  becomes  all  the  more 
important. 

The  choice  of  the  wet-nurse,  when  possible,  should 
always  be  left  to  the  family  physician ;  indeed,  a 
doctor's  examination  of  her  milk  and  her  baby  should 


48  INFANCY. 

always  be  obtained.  The  system  recently  established 
at  the  nurses'  directories  in  our  large  cities  of  having 
certified  wet-nurses  is  a  very  valuable  step  forward, 
and  should  be  encouraged  by  the  public. 

THE  NURSING   OF   INFANTS. 

I  have  elsewhere  written1  as  follows,  when  on  the 
subject  of  bottle-feeding : 

How  much  food  does  a  child  require  in  twenty-four 
hours  ?  So  much  depends  on  the  infant ;  if  the  bowels 
be  normal  and  there  is  no  evidence  of  indigestion,  the 
breath  sweet,  and  the  child  seems  desirous  for  more  after 
it  has  finished  its  bottle,  there  is  no  reason  why  it  should 
i  not  be  satisfied.  A  child  of  a  month  should  be  nursed 
about _ten  times  in  twenty-four  hours,  every  two  hours 
during  the  """day  and  three  hours  during  the  night;  at 
each  nursing  it  should  take  from  two  to  three  ounces 
of  milk.  At  the  age  of  about  three  months  it  will 
probably  nurse  only  about  eight  times,  taking  about 
six  ounces  at  each  feeding;  at  the  end  of  about  six 
months  it  will  take  about  eight  ounces.  I  believe  that 
this  would  represent  about  the  amount  of  breast-milk 
that  such  a  child  would  receive. 

The  child  gets  the  same  food  as  does  an  adult ;  that 
is  to  say,  the  milk  which  forms  its  diet  is  composed  of 
all  the  articles  of  food  that  enter  into  the  diet  required 
by  a  human  being.  These  may  be  divided  into  five 
classes :  water,  casein  (curds)  or  albuminoids,  salts 
which  go  to  the  formation  of  bones  and  secretions, 
fats,  and  sugar,  which  are  burned  up  to  make  animal 
heat,  and  also  are  valuable  in  nutrition.  Eighty-seven 
parts  of  a  child's  food  is  water,  but  then  we  know  that 
seventy  per  cent,  of  the  human  body-weight  is  water. 
Mother's  milk  is  a  bland,  watery  substance,  sweetish  to 
the  taste,  and  has  the  property  of  forming  curds  in 

1  Annals  of  Hygiene,  July  1,  1886. 


CARE   OF  NEW-BORN  INFANT.  49 

flakes.  This  is  readily  noticed  in  children  who  have 
eaten  too  much,  when  the  milk  has  been  regurgitated ; 
whereas  the  milk  of  the  cow  precipitates  in  heavy 
masses  as  a  rule,  and  is  on  that  account  difficult  of 
digestion. 

A  healthy  infant,  if  properly  instructed  in  the  earlier 
hours  of  its  life,  will  awaken  with  the  regularity  of 
clock-work  and  seek  its  meal  every  second  hour.  It 
should  be  placed  at  the  breasts  alternately,  and  after  it 
has  received  its  nourishment  it  will  probably  fall  asleep, 
showing  no  evidence  of  indigestion  or  flatulence  so  fre- 
quent in  bottle-fed  children.  Babies  are  very  apt  to 
get  into  bad  habits  of  falling  asleep  after  taking  two 
or  three  mouthfuls.  If  this  habit  should  be  encour- 
aged, it  is  one  very  difficult  to  break.  It  should  be 
promptly  awakened  and  made  to  continue  the  meal 
until  it  has  taken  the  sufficient  amount. 

About  the  third  month  a  child  should  nurse  about 
every  three  hours,  or  possibly,  if  it  is  a  large  child, 
craves  food  and  takes  a  great  deal  at  once,  every  two 
hours  during  the  day,  and  a  longer  interval  at  night. 
If  the  mother  has  a  very  free  flow  of  milk,  more  indeed 
than  she  can  possibly  retain,  it  is  well  for  her  to  wear 
the  ordinary  disk  or  cracker-shaped  nipple-glass  during 
the  daytime,  with  a  towel  pinned  over  it,  which  will 
take  off  the  surplus  milk,  and  will  prevent  her  from 
being  constantly  wet  and  catching  cold. 

The  question  is  often  asked,  How  long  should  a  child 
be  nursed?  The  universal  opinion  seems  to  be  that 
for  at  least  six  months  the  child  should  take  nothing 
but  its  mother's  milk;  but  of  course  if  it  is  feeble 
and  weak  from  difficult  labor,  or  disease,  it  should  be 
kept  at  the  breast  very  much  longer,  and  should  a 
summer  intervene,  as  it  would  for  a  child  born  in  Octo- 
ber or  November,  no  attempt  should  be  made  at  wean- 
ing, unless  advised  by  the  family  physician,  until  the  fol- 
lowing autumn.  After  the  age  of  six  months,  all  things 
c       d  5 


50  INFANCY. 

being  equal  and  the  child  being  healthy,  it  may  be  well 
to  gradually  enlarge  its  bill  of  fare,  in  order  to  accustom 
it  to  a  change  in  diet,  or  to  prepare  for  any  change  that 
may  become  necessary.  It  has  been  said  that  a  child 
digests  bottle-food  when  it  also  takes  breast-milk,  and 
therefore  that  weaning  should  be  a  gradual  process, — 
so  gradual  indeed  as  to  take  several  months  for  its 
accomplishment.  When  it  is  deemed  desirable  to  sub- 
stitute breast-milk,  the  bottle  should  be  given  in  the 
daytime,  after  the  morning  bath ;  or  better  still,  if  the 
nurse  has  the  child,  give  it  the  breast  in  daytime 
that  the  mother  may  get  her  night's  rest.  By  this  time 
the  child  takes,  as  we  have  noted,  more  food  at  each 
nursing  and  nurses  less  frequently,  and  now  it  could 
have  a  bottle  at  about  ten  or  eleven  o'clock  at  night, 
when  the  mother  retires ;  in  this  way  she  can  nurse  the 
child  at  the  early  morning  hour,  and  thus  avoid  the 
exposure  of  getting  up  and  preparing  a  bottle  of  food 
at  that  hour,  if  she  takes  charge  of  the  child  herself. 


CHAPTER  III. 


BOTTLE-FEEDING. 


The  Child's  Bottle  and  how  to  prepare  it — Great  Care  in  preparing 
the  Bottle  must  he  exercised — An  Efficient  Nurse  indispensable 
to  the  Welfare  of  the  Child — A  study  of  Milk — Condensed 
Milk  and  fresh  Evaporated  Milk. 

If  I  have  impressed  sufficiently  upon  the  reader  the 
importance  of  care  in  the  selection  of  a  wet-nurse,  I 
did  not  do  so  with  the  object  of  undervaluing  the  sub- 
ject of  bottle-feeding  by  contrast,  although  there  is  no 
question  but  what  the  valuable  suggestions,  the  out- 
growth of  careful  study,  that  have  been  published  by 


BOTTLE-FEEDING.  51 

such  writers  as  Leeds,  Smith,  Meigs,  Jacoby,  and 
others  in  this  country  have  impressed  upon  the  com- 
munity the  fact  that  the  raising  of  children  by  means 
of  the  bottle  is  by  no  means  as  difficult  a  matter  as  it 
was  thought  even  ten  years  ago.  They  have  all 
premised  their  teachings  by  impressing  that  care  is  the 
primary  step  to  success.  If  it  is  a  difficult  matter  to 
keep  a  wet-nurse  in  order,  it  is  no  less  difficult  to  give 
the  requisite  attention  to  each  bottle.  One  bottle  of 
tainted  milk  may  be  fatal  to  an  infant,  and  though  a 
mother,  or  nurse,  may  day  after  day  watch  with  the 
most  zealous  care  the  preparation  of  the  baby's  food, 
the  souring  of  the  milk,  its  admixture  with  contaminated 
water,  the  change  of  pasture  of  the  cow,  may  bring  oh 
an  attack  of  diarrhoea  or  vomiting  which  would  be 
uncontrollable.  I  wish,  therefore,  to  impress  upon  all 
those  who  have  anything  to  do  with  the  bottle-feeding 
of  children,  that  when  I  state  that  a  child  that  is  not 
exposed  to  the  dangers  of  a  large  city  in  the  summer- 
time— and  I  make  this  exception — can  be  brought  up  on 
the  bottle  from  the  day  of  its  birth  and  be  free  from  dis- 
ease, become  strong  and  healthy,  it  is  provided  the  same 
attention  is  given  to  it  as  would  be  given  by  a  mother 
to  her  new-born  nursing  babe. 

The  first  requisite  for  carrying  out  bottle-feeding 
with  thoroughness  is  that  somebody  should  take  charge 
of  the  child  who  has  a  special  interest  in  it.  If  I  am 
talking  to  a  young  mother  whose  milk  has  given  out,  or 
whom  the  family  physician  has  advised  to  bottle-feed 
her  child,  then  she  is  the  one  to  undertake  the  work, 
and  either  to  prepare  each  bottle,  or  to  superintend  its 
preparation  for  a  time  at  least.  Possibly  she  has  had  a 
wet-nurse  whose  milk  has  gone,  and  it  has  been  decided 
to  use  a  bottle  instead  of  procuring  another.  Then,  let 
the  nurse  undertake  the  duties.  She  has  a  special  in- 
terest in  the  child  that  has  drawn  its  nourishment  from 
her  breast.     If  not,  then  get  some  middle-aged  woman, 


52  INFANCY. 

not  too  old,  or  cranky,  or  over-burdened  by  previous 
experience,  or  on  the  contrary,  a  small  chit  of  a  girl 
who  would  require  a  nurse  to  look  after  her.  Strange 
to  say,  these  are  often  engaged  as  child-nurses,  and  no 
wonder  the  doctors  are  kept  busy.  Choose  a  middle-aged 
woman,  or  a  strong,  healthy  young  woman  of  intelligence, 
— one  who  is  bright,  cheerful,  satisfied.  Make  your 
pecuniary  arrangements  with  her  perfectly  satisfactory, 
so  that  she  has  nothing  on  her  mind  whatever.  After 
you  have  tested  her  ability,  give  her  your  entire  con- 
fidence ;  let  her  see  that  she  is  trusted.  It  is  well  that 
the  child  and  nurse  should  have  a  room  to  themselves 
near  to  the  mother's  bedroom,  and  this  room  should 
have  in  it  two  things  of  great  importance  :  one  a  small 
sick-room  refrigerator,  the  other  a  gas-lamp  or  some- 
thing by  which  the  milk  or  water  can  be  readily  heated. 
It  is  necessary  to  have  a  nursing-bottle  holding  about 
eight  ounces.  A  child  a  month  old  will  take  not  quite 
one-half  of  this  at  each  nursing.  At  the  age  of  six 
months  it  should  take  at  one  feeding  this  bottle  full. 

The  fresher  the  milk,  the  more  readily  it  will  be 
digested ;  indeed,  I  feel  satisfied  that  the  warm  milk, 
just  from  the  cow,  is  far  more  digestible  than  that 
which  has  been  kept  with  every  precaution  for  a  few 
hours.  There  must  be  some  change  which  milk  under- 
goes, as  it  is  noted  by  all  observers  that  the  milk  when 
warm  from  the  cow  is  but  slightly  acid,  or  neutral,  in  its 
action  to  litmus-paper,  but  after  it  has  stood  for  a  while 
always  shows  a  very  decided  acid  change.  Mothers' 
milk  is  always  alkaline. 

The  greater  part  of  the  secret  of  success  in  bottle- 
feeding  is  to  have  pure,  fresh  milk  ;  and  I  would  say 
beforehand  that  if  there  is  the  least  doubt  of  the  char- 
acter of  the  milk  served,  there  should  be  no  hesitation 
about  putting  the  child  at  once  upon  condensed  milk 
until  this  matter  is  thoroughly  arranged.  Although 
one  may  be  most  careful  in  the  selection  of  a  milkman, 


BOTTLE-FEEDING.  53 

in  the  city,  the  jolting  that  the  milk  gets  in  transit,  the 
risk  that  is  run  from  diseased  cows,  dirty  cans,  con- 
taminated water  in  milk-houses,  is  by  no  means  small, 
and  especially  during  the  heated  season,  when  the 
child's  intestinal  tract  is  weakened.  These  causes  of 
bad  milk  are  very  apt  to  be  followed  by  disease ;  pos- 
sibly this  accounts  for  the  fact  that  the  milk  from 
the  same  dairy  will  disagree  with  the  child  in  summer 
that  has  agreed  perfectly  during  the  spring  months. 

So  much  attention  has  been  paid  to  this  matter  re- 
cently that  the  public  has  become  interested  in  the 
establishment  of  dairies  where  every  precaution  is  taken 
to  secure  the  very  best  of  milk  by  legislative  interference. 
The  pasture  and  winter-feeding  should  be  regulated  ;  the 
health  of  the  cattle,  the  methods  of  preserving  the 
milk,  and  its  transportation,  looked  after;  the  milk 
inspectors  should  be  on  the  alert  to  prevent  the  intro- 
duction of  such  substances  as  boracic  acid  or  salicylic 
acid  to  preserve  the  milk.  Great  care  should  be  taken 
in  the  selection  of  milk,  and  in  its  preservation,  even 
after  it  has  reached  the  house,  until  used.  The  milk 
should  be  always,  for  a  very  young  child,  be  tested 
with  litmus  ;  if  it  is  alkaline,  it  has  been  made  so  by 
the  addition  of  some  preservative.  Cows'  milk  always 
presents  to  litmus-paper  more  or  less  acid  reaction, 
turning  the  litmus  red.  If  there  is  the  slightest  suspi- 
cion that  the  milk  is  not  very  fresh,  or  that  it  has  been 
subjected  to  much  jolting,  my  opinion  is  that  it  should 
be  boiled  at  once,  and  then  put  in  a  refrigerator  to  be 
warmed  for  each  bottle.  The  boiling  will  destroy  its 
ferments,  and  in  that  way  diminish  the  chances  for 
intestinal  disturbances. 

The  question  of  obtaining  milk  from  a  single  cow  is 
one  that  has  been  frequently  insisted  upon,  and  if  one 
is  satisfied  that  such  milk  is  obtained  and  is  found  to 
have  agreed  with  the  child  it  may  have  many  advan- 
tages, but  I  think  that  the  ordinary  mixed  milk  from 

5* 


54  INFANCY. 

a  dairy  of  common  cattle  will  be  less  liable  to  daily 
changes ;  it  will  maintain,  as  it  were,  an  average.  Not 
only  should  the  milk  be  pure  and  sweet,  but  it  should 
be  free  from  all  matters  that  carry  with  them  disease. 
Our  medical  literature  contains  very  many  authentic 
cases  of  scarlet  fever,  typhoid  fever,  and  diphtheria, 
which  were  undoubtedly  carried  from  the  dairy  by  means 
of  the  milk,  the  farmer's  family  suffering  at  the  time 
from  the  disease  in  question.  If,  for  instance,  the  water 
of  the  milk-house  should  be  contaminated  by  an  out- 
house well,  and  the  washing  of  the  pans  convey  these 
materials  to  the  milk,  the  result  of  course  would  be 
apparent;  or,  indeed,  milk  undoubtedly  is  frequently 
diluted,  and  the  water  will  carry  the  germs  with  it. 
Milk  also  has  the  propensity  of  absorbing  odors,  and 
gases  that  probably  have  with  them  the  germs  of  dis- 
ease may  be  absorbed  by  the  milk  and  carried  that 
way.  Milk  also  may  contain  the  germs  of  disease 
affecting  the  cow  herself;  so  we  see  that  there  is  a  great 
risk  to  be  run,  and  were  we  ever  so  careful  and  watch- 
ful we  could  only  avoid  the  most  apparent  evils,  and 
we  will  have  to  trust  to  Providence  to  save  us  from 
the  others. 

If  each  householder  was  more  particular  about  his 
milk,  gave  it  the  strictest  watching,  and  if  the  laws  in 
regard  to  that  outrageous  and  most  criminal  proceeding 
the  adulteration,  or  diluting  of  milk,  should  be  rigidly 
enforced,  dairymen  would  soon  feel  the  importance  of 
obtaining  and  sustaining  a  reputation  for  honesty.  It 
is  a  very  difficult  matter  to  reach  the  legislators  of  the 
land,  those  who  make  its  laws,  but  possibly  by  placing 
these  matters  in  a  clear  way  before  their  wives,  they  will 
be  made  to  see  the  criminality  of  adulteration  of  food 
when  it  becomes  a  matter  of  their  own  individual 
interest. 

I  dwell  at  great  length  upon  the  importance  of  step 
by  step  considering  the  preparation  of  a  child's  bottle, 


BOTTLE-FEEDING.  55 

and  this  is  done  because  it  becomes  a  monotonous  work, 
and  unless  the  mother  sees  to  it  personally,  no  nurse, 
however  devoted,  may  not  some  time  or  another  become 
a  little  careless,  and  the  result  may  be  the  souring  of 
the  milk,  formation  of  the  curd,  and  inflammation  of 
the  bowels  and  its  consequences. 

Dr.  W.  Thornton  Parker,  of  Newport,  Rhode  Island, 
recommends  a  pure  gum  nipple,  witli  two  holes  as  far 
apart  as  possible,  as  the  best  for  the  nursing-bottle,  and 
also  says  regarding  the  matter  as  follows :  "  When  there 
is  only  one  hole,  the  infant  in  nursing  compresses  the 
nipple  and  sends  the  milk  in  a  stream  in  such  a  manner 
as  often  to  nearly  strangle  itself.  Milk  coming  through 
one  hole  is  not  as  comfortable  as  when  it  comes  through 
two,  and  the  effort  of  nursing  becomes  disagreeable  and 
wearisome  to  the  little  feeder.  The  best  way  to  nurse 
an  infant  is  by  holding  it  in  the  arms,  and  give  it  the 
bottle  in  the  same  position  and  height  as  if  it  were 
really  being  nursed  by  its  mother.  When  it  has  fin- 
ished nursing,  the  bottle  should  be  removed,  emptied, 
and  cleansed.  Never  should  the  bottle  be  left  in  the 
infant's  care  to  use  at  will." 

We  all  acknowledge 1  that  cow's  milk  has  the  follow- 
ing advantages :  it  serves  as  the  basis  for  the  prepara- 
tion of  a  milk  resembling  that  of  the  human  mother,  it 
possesses  all  the  ingredients  that  are  necessary  for  nutri- 
tion, it  is  easy  to  obtain.  Its  disadvantages  are,  that 
the  relative  proportion  existing  between  its  different 
constituents  is  not  that  found  in  mother's  milk,  it  pos- 
sesses a  form  of  casein  which  forms  hard  curds,  this 
casein  exists  in  larger  amounts,  at  least  twice  or  more 
than  in  human  milk. 

A  certain  time  must  elapse  during  which  the  milk 
undergoes  possibly  some  alteration  from  exposure  to 


*I  quote  here  from  my  paper  read  before  the  convention  of 
State  Boards  of  Health  in  May,  1886. 


56  INFANCY. 

the  air,  is  liable  to  be  tainted  with  the  germs  which 
produce  decomposition,  and  this  indeed  is  the  greatest 
objection  to  its  use  in  our  large  cities.  It  is  acid, 
though  precisely  what  effect  this  has,  or  what  it  is  due 
to,  is  not  exactly  clear  to  my  mind. 

But  these  objections  can  be  readily  obviated  by  the 
following  means : 

The  milk  from  an  ordinary  dairy  should  be  obtained 
as  fresh  as  possible,  mix  together  half  a  pint  of  this 
milk  and  half  a  pint  of  pure  water,  and  to  this  should 
be  added  about  two  hundred  grains  or  two  heaping  tea- 
spoonfuls  of  milk  sugar,  with  four  grains  of  bicarbonate 
of  soda ;  it  should  then  be  brought  to  a  boil,  after  which 
two  tablespoonfuls  of  cream  should  be  stirred  in,  and  it 
is  ready  for  use,  to  be  given  by  bottle  or  drinking-cup, 
at  about  the  body  temperature. 

We  have  here  a  mixture  which,  according  to  Leeds, 
closely  resembles  mother's  milk ;  we  have  also  a  prep- 
aration which  has  been  freed  by  boiling  from  the  ob- 
jection stated  above  to  cow's  milk,  that  due  to  a  ten- 
dency to  fermentation,  and  indeed  the  milk  is  rendered 
more  digestible  by  it. 

For  new-born  children,  or  those  a  month  or  two  old, 
we  may  diminish  the  amount  of  casein  and  increase  the 
amount  of  sugar  by  the  following  means :  Take  one 
ounce  of  ordinary  milk,  three  ounces  of  water;  add 
one  ounce  of  ordinary  cream  and  about  a  level  tea- 
spoonful  and  a  half  (eighty  grains)  of  milk  sugar.  In- 
deed, it  is  better  to  run  the  risk  of  making  a  mixture 
with  too  little  casein  than  with  too  much,  gradually  in- 
creasing strength  of  the  milk  by  diminishing  the  water, 
as  the  child  grows  older ;  but  it  should  also  be  borne 
in  mind  that  as  we  increase  the  water  we  should  also 
increase  the  carbo-hydrates,  by  adding  either  sugar  of 
milk  or  some  of  the  malted  foods.  Sugar  of  milk 
rapidly  sours  and  turns  to  lactic  acid  when  dissolved  in 
water  ;  and,  indeed,  I  believe  that  on  this  account  there 


BOTTLE-FEEDING.  57 

is  little  choice  between  it  and  cane  sugar.  In  a  case  of 
diarrhoea,  I  would  leave  out  sugar  altogether.  My  own 
experience  teaches  me  that;  with  care,  cane  sugar  has  not 
the  disadvantages  in  most  cases,  in  winter,  that  some  fear. 

Or  we  may  dilute  the  milk  as  follows : 

If  to  a  four-ounce  mixture  composed  of  one  ounce 
of  ordinary  milk  and  three  ounces  of  water  we  add 
one  ounce  of  ordinary  cream  (about  fourteen  and  a 
half  per  cent,  of  butter)  and  about  eighty  grains  of 
sugar  of  milk  (a  level  teaspoonful  and  a  half),1  we  will 
get  a  result  which  closely  resembles  woman's  milk, 
though  containing  less  casein  and  more  sugar  than  most 
authorities  give  as  the  result  of  their  investigation. 
Still,  for  very  young  infants  this  is  an  advantage. 

Take  two  ounces  of  ordinary  fresh  milk,  add  two 
ounces  of  water.  Now,  add  two  tablespoonfuls  of 
ordinary  cream  of  good  quality  and  a  heaping  tea- 
spoonful  (about  one  hundred  grains)  of  milk  sugar. 
Cream  itself  contains  about  three  per  cent,  of  casein. 
But  I  have  insisted  that  there  must  be  a  certain  amount 
of  lime  added  to  the  mixture,  and  for  this  purpose 
lime-water  can  be  used,  a  tablespoonful  to  the  bottle 
replacing  one  of  water.  As  I  have  before  suggested, 
if  there  is  the  least  doubt  about  the  keeping  of  milk 
it  should  be  immediately  brought  to  a  boil  and  then 
placed  in  the  refrigerator,  a  certain  amount  being  with- 
drawn and  heated  over  for  each  bottle.  Under  no 
circumstances  should  a  bottle  of  made-food  be  heated 
again, — that  is  to  say,  what  remains  over  after  the  child 
is  nursed  should  be  thrown  away.  It  can  readily  be 
understood  why  this  is  the  case  when  we  consider  that 
as  the  child  draws  milk  from  the  bottle  the  air  which 

1 A  silver  teaspoon,  such  as  is  in  ordinary  use,  when  filled  with 
sugar  of  milk  and  "levelled,"  will  contain  about  fifty-seven  grains ; 
a  plated  teaspoon  contains  about  five  grains  less, — practically  one 
drachm.  A  "heaping"  silver  teaspoon  holds  about  one  hundred 
and  seventeen  grains  of  sugar  of  milk, — practically  two  drachms. 


58  INFANCY. 

replaces  the  milk  is  that  exhaled  by  the  child,  and  acts 
most  quickly  as  a  putrefacient. 

The  milk  should  be  given  to  the  child  about  the 
temperature  of  the  body  or  a  little  warmer, — that  is  to 
say,  about  as  hot  as  can  be  borne  in  the  mouth, — a 
temperature  of  100°.  Dr.  Thornton  Parker,  of  New- 
port, Rhode  Island,  says  that  the  best  method  of  pre- 
paring the  milk  for  the  bottle  is  as  follows  :  For  a  child 
of  three  months  old  take  of  pure  Alclerney  milk  one 
cupful  (one  gill),  boiling  water  two  cupfuls  (one-half 
pint),  lime-water  one  tablespoonful,  sugar  of  milk  one 
teaspoonful.  Mix  carefully.  Each  bottle  should  be 
tasted,  to  see  that  there  is  nothing  wrong  with  it  and 
also  to  see  that  it  draws  well  through  the  nipple.  A 
black  rubber  nipple  is  certainly  the  best  to  use,  and  there 
should  be  a  number  of  them,  so  that  a  clean  one  that 
has  been  well  washed  may  be  used  each  time.  After 
a  child  has  taken  its  bottle,  if  it  is  drowsy  it  should  be 
laid  gently  on  its  right  side  and  allowed  to  sleep.  The 
clothes  should  be  thoroughly  loosened,  and  under  no 
circumstances  should  it  be  allowed  immediately  after 
taking  its  food  to  be  tossed  or  romped  with,  which 
unfortunately  is  a  very  common  practice  and  always 
ends  in  indigestion. 

So  far  we  have  spoken  entirely  of  cow's  milk  as  a 
substitute  for  that  of  the  breast ;  but,  as  has  been 
heretofore  noted,  the  tendency  in  cow's  milk  is  to  the 
formation  of  curds  that  are  compact  and  indigestible, 
and,  though  this  can  be  to  a  certain  extent  obviated 
by  diluting  the  milk  as  recommended,  there  are  times 
when,  owing  to  the  difficulty  in  obtaining  the  pure 
cow's  milk,  which  is  primarily  essential,  or  owing  to 
the  delicate  digestion  of  the  child,  cow's  milk  seems 
to  be  indigestible.  We  are  obliged  to  have  recourse  to 
some  process  that  will  render  the  milk  more  digestible, 
and  for  this  purpose  various  means  have  been  adopted 
to  make  up  a  child's  bottle. 


BOTTLE-FEEDING.  59 

This  brings  us  to  the  subject  of  condensed  milk.  A 
reliable  brand  of  Borden  or  Canfield's  has  the  following 
advantages :  When  diluted  with  from  ten  to  five  parts 
of  water,  it  represents  mother's  milk  pretty  closely, 
depending  on  the  age  of  the  child,  with  the  exception 
that  there  is  less  cream,  but  to  a  pint  of  this  mixture 
four  tablespoonfuls  can  readily  be  added.  The  evapo- 
ration of  the  milk  in  its  preparation  has  destroyed  its 
tendency  to  fermentation  to  a  great  extent.  This  most 
certainly  is  a  great  advantage.  It  will  coagulate  in 
flakes,  and  does  not  require  the  addition  of  any  sugar, 
as  by  analysis  it  is  shown  that  when  the  mixture  is  thus 
prepared  the  amount  of  sugar  it  contains  is  about 
equal  to  that  in  mother's  milk.  It  can  be  universally 
obtained,  and  is  useful  on  that  score ;  its  disadvantage 
in  many  instances  is  due  to  the  cane  sugar,  and  some 
object  to  it  on  the  ground  that  it  is  supposed  in  many 
cases  to  lead  to  rickets.  My  own  experience  does  not 
bear  this  out,  though  certainly  if  I  were  to  find  that  a 
child  fed  on  condensed  milk  should  show  undue  acidity, 
either  in  its  stools  or  its  breath,  due  to  the  presence  of 
lactic  acid,  I  would  at  once  change  its  diet.  This,  care- 
ful watching  should  avoid. 

In  summer  weather  the  presence  of  cane  sugar,  which 
is  a  decided  laxative,  is  objectionable,  and  herein  exists 
the  great  difficulty  of  the  proper  selection  of  a  food  for 
that  season. 

In  order  to  counteract  any  tendency  to  rickets,  I 
usually  incorporate  in  the  milk  some  lime, — either  lime- 
water,  or  still  better,  I  think,  the  lactophosphate  and 
carbonate  of  lime ;  indeed,  I  would  establish  this  as  a 
rule  in  the  preparation  of  all  milk  foods  that  require 
the  addition  of  sugar. 

Let  us  study  for  a  moment  the  question  of  the  "  fresh 
evaporated  milk,"  served  daily  in  some  cities  by  the 
Canfield  Company,  and  which,  I  think,  offers  for  the 
future  the  best  field  for  infant  feeding  in  those  cities 


60  INFANCY. 

where  it  is  daily  supplied,  especially  in  summer-time. 
We  may  add  to  one  part  of  it  seven  parts  of  water 
previously  boiled  or  filtered. 

We  find  that  it  will  be  necessary  to  add  to  the  half- 
pint  of  the  above  mixture  of  evaporated  milk,  two 
tablespoonfuls  of  cream  and  two  heaping  teaspoonfuls 
of  sugar  of  milk.  This  will  be  equal  to  cow's  milk, 
with  about  the  same  percentage  of  casein  as  mother's 
milk.  The  absence  of  cane  sugar  in  this  preparation 
renders  it  most  valuable  in  summer  in  our  large  cities 
when  diarrhoea  is  prevalent.  Indeed,  in  such  cases  half 
an  ounce  of  this  milk  in  a  graduated  glass  with  four 
ounces  of  water,  previously  boiled  and  filtered,  given  at 
the  temperature  of  the  body,  about  99°,  without  adding 
cream  or  sugar,  would  in  many  cases  be  a  most  suitable 
diet.  If  the  bowels  are  loose,  lime-water  could  be  used. 
Unquestionably,  disorders  of  the  intestinal  tract  are  pro- 
duced by  fermentation  and  also  by  mechanical  irritation 
of  undigested  curds,  and  this  is  often  due,  not  alone  to 
the  method  of  preparing  the  food,  but  also  to  the  de- 
ficient supply  of  the  gastric  juices.  If  a  large  supply 
of  gastric  juice  could  be  encouraged,  both  of  these 
causes  would  cease  to  exist,  as  the  acid  mixture  is  anti- 
putrefactive as  well  as  digestive.  We  are  often  obliged 
to  use  some  means  so  as  to  prepare  the  milk  and  destroy 
its  ferments,  and  to  diminish  its  casein,  or  so  affect  it 
as  to  allow  precipitation  in  fine  masses.  The  former  is 
readily  accomplished  by  boiling,  or  by  subjecting  the 
milk  to  heated  steam,  the  latter  by  several  means  now 
in  vogue : 

The  first,  by  rendering  the  milk  alkaline,  which  re- 
tards in  a  measure  the  coagulating  property  of  the  gas- 
tric juice. 

The  second,  by  diluting  the  milk  with  water,  which 
diminishes  the  percentage  of  casein. 

The  third,  by  thoroughly  incorporating  with  it  some 
material,  such  as  gelatin,  or  a  small  amount  of  starchy 


BOTTLE-FEEDING.  61 

matter,  such  as  oatmeal-water,  that  will  intimately  in- 
corporate itself  in  the  casein  as  it  falls,  and  thus  allow 
the  gastric  juice  to  completely  attack  it. 

The  fourth,  by  partially  predigesting  the  casein,  pep- 
tonize it  as  it  is  called,  before  it  enters  the  stomach. 

We  have,  in  addition  to  these,  various  other  prepara- 
tions, which  are  sometimes  added  to  the  milk  to  render 
it  more  nutritious  ;  for  example,  soluble  carbo-hydrates, 
as  dextrine,  glucose,  or  substances  rich  in  albuminous 
matters.  This,  in  fact,  covers  the  whole  ground  of  the 
various  preparations  used  in  the  bottle-feeding  of  in- 
fants, and  you  will  thus  see  that  they  all  have  some 
scientific  basis  to  work  upon,  and  their  choice  depends 
on  questions  of  expediency  and  reliability,  which  should 
be  studied  in  connection  with  each  particular  case. 

Cow's  milk  can  readily  be  rendered  alkaline  by 
the  addition  of  lime-water  in  large  amounts,  soda  or 
potash,  and  the  curd  affected  thereby.  I  think  the  im- 
portance of  alkalinity  is  somewhat  over-estimated, — 
that  is,  the  tendency  seems  to  be  to  put  too  much  soda 
in  the  milk;  all  that  is  required  is  to  make  it  neutral, 
even  for  peptonizing  purposes. 

When  lime-water  is  added  to  the  bottle,  two  table- 
spoonfuls  to  a  four-ounce  mixture  will  be  in  most 
cases  sufficient.  It  is  always  well  to  consult  the  phy- 
sician before  lime,  or  soda,  is  added  to  the  bottle  of 
milk;  there  may  be  reasons  why  a  choice  should  be 
made  between  the  two.  Indeed,  too  much  alkali  may 
weaken  the  digestive  organs  and  make  the  child  flatu- 
lent and  dyspeptic.  Vichy  water  is  a  very  good  addi- 
tion to  milk  instead  of  lime-water ;  if  the  child  should 
continue  to  pass  curds,  it  should  be  used  in  the  same 
strength  as  lime-water.  Dilution  with  water  is  a  very 
important  matter,  because  by  weakening  the  milk  with 
the  object  of  diluting  the  curd  we  also  diminish  the  fat 
or  cream,  the  sugar  and  salts.  Now,  as  all  of  these  are 
essential  to  nutrition,  it  is  obvious  that  by  diluting  them 

6 


62  INFANCY. 

we  are  obliged  to  give  the  child  greater  bulk  than  it 
would  otherwise  take,  aud  to  overcome  this  difficulty  it  is 
necessary  to  add  cream,  sugar,  and  salts  to  the  bottle  in 
its  preparation.  A  question  of  the  digestion  of  fat  is  a 
very  important  one.  The  fats  and  sugars  serve  pretty 
much  the  same  purpose  in  the  system ;  they  are  the  so- 
called  carbo-hydrates,  and  go  to  the  formation  of  animal 
heat,  but  the  fats  serve  even  a  greater  purpose :  they  are 
found  essential  to  nutrition;  they  give  strength,  and  act 
in  that  way  the  same  as  the  curd  or  nitrogenous  princi- 
ple. Fat  is  in  greatest  demand  at  the  time  when  animal 
heat  is  the  most  required,  that  is,  during  the  winter 
mouths;  the  fats  aud  soluble  carbo-hydrates  when  sup- 
plied in  excess  are  stored  for  future  use;  their  excess  in 
hot  seasons  is  productive  of  intestinal  disorders.  In 
such  cases  a  change  to  soups,  or  albuminous  water, 
made  by  dissolving  the  white  of  egg  in  water,  makes  a 
nutritious  diet  and  is  a  valuable  change.  The  oils  when 
stored  give  a  condition  of  body  which  is  firm  and  elastic 
to  the  touch,  and  when  this  reserve  is  called  upon  the 
emaciation  is  gradual.  On  the  contrary,  when  the  stor- 
age takes  place  from  excess  of  sugar  fat,  the  fat  is  not 
staying  and  its  disappearance  is  sudden.  This  is  well 
seen  in  children  fattened  on  condensed  milk  to  which 
no  cream  has  been  added.  It  is  admirably  described 
by  Dr.  S.  Weir  Mitchell  in  his  book. 

Lessen,  then,  the  amount  of  cream  and  sugar  for  the 
summer  season,  and  increase  the  nitrogenous  elements. 

The  question  so  often  arises  as  to  the  exact  value  of 
condensed  milk  and  the  cases  in  which  it  may  be  used, 
I  can  well  be  pardoned  if  I  again  dwell  upon  it  for  a 
few  moments.  The  intense  heat  which  is  used  in 
making  it  has  destroyed  the  germs  of  putrefaction 
and  thereby  helped  to  preserve  it.  This  is  a  very 
great  gain.  Then  also  the  statement  that  only  fresh, 
sweet  milk  can  be  condensed  is  undoubtedly  true,  as 
the  odor  which  arises  from  stale  milk  would  at  once  ex- 


BOTTLE-FEEDING.  63 

pose  its  character.  The  soft  flocculent  masses  into  which 
it  is  coagulated  are  of  immense  advantage,  especially 
in  young  infants ;  it  is  the  nearest  approach  to  mother's 
milk.  The  only  question  which  is  at  all  worthy  of 
consideration  is  that  of  the  sugar  which  it  contains, 
and  the  deficiency  of  cream  when  the  mixture  is  diluted 
compared  with  that  of  mother's  milk.  For  instance, 
a  bottle  made  up  of  an  ounce  of  condensed  milk 
(mothers  and  nurses  should  use  a  large  graduated 
measure  in  preparing  babies'  bottles,  it  is  so  much  more 
reliable  than  the  ordinary  tablespoon),  with  ten  ounces 
of  water,  is  almost  identical  in  its  composition  to 
mother's  milk,  possessing  very  much  the  same  quality, 
with  the  exception  that  it  has  cane  sugar  instead  of 
sugar  of  milk,  and  has  less  cream.  For  a  very  young 
infant,  one  who  has  been  suddenly  deprived  of  breast- 
milk,  a  mixture  of  this  kind  probably  possesses  greater 
advantages  than  any  other  milk  food,  and  I  feel  satis- 
fied that  it  will  agree  best  and  be  more  easily  prepared 
than  any  other  bottle.  The  water  should  be  previously 
boiled  and  filtered,  the  can  kept  in  a  cold  place,  well 
covered,  and  each  bottle  made  up  fresh.  I  would  even 
prefer  this  form  of  condensed  milk  to  the  evaporated 
fresh  milk,  which  has  no  sugar,  for  a  very  young  infant, 
unless  it  is  previously  understood  that  to  the  freshly- 
evaporated  milk,  sugar  of  milk  should  be  added  to  each 
bottle. 

Let  me,  then,  be  distinctly  understood  as  recommend- 
ing condensed  milk,  not  as  a  regular  article  of  diet,  but 
simply  to  be  used  to  bridge  over  that  most  delicate 
period  in  a  child's  existence  when  it  is  deprived,  at  an 
early  age,  of  breast-milk,  or  when  there  are  doubts  as 
regards  the  character  of  the  cow's  milk  from  which  its 
food  is  to  be  made.  It  serves  as  a  bridge  to  carry  the 
child  safely  over  a  change  in  the  character  of  its  food 
which  is  all-important ;  it  also  has  advantages  of  being 
always  at  hand,  and  when  obtained  fresh  and  from 


64  INFANCY. 

reliable  sources  is  usually  of  about  the  same  quality.  I 
have  seen  children  a  year  or  more  old  brought  up 
entirely  on  condensed  milk  with  every  appearance  of 
health  and  strength,  and  they  are  unusually  fat  children, 
as  a  rule,  but  at  the  same  time  I  would  not  advise  it. 

Of  course,  as  a  child  grows  older  its  digestion  be- 
comes stronger ;  it  becomes,  in  fact,  accustomed  to 
its  food.  A  change  can  be  made  by  adding  cream  to 
each  bottle  in  the  proportion  before  recommended, — 
that  is,  to  a  half-pint  of  the  condensed  milk  as  pre- 
pared above  an  ounce  of  ordinary  cream  can  be  added. 
If  one  lives  in  the  country  and  milk  can  be  obtained 
warm,  fresh  from  the  cow,  it  can  be  used  instead  of 
condensed  milk,  but  I  must  confess  that  I  would  not 
recommend  a  city  child  to  be  given,  shortly  after  its 
birth,  ordinary  cow's  milk  and  water. 

In  addition  to  those  recommended  already,  includ- 
ing the  mixture  of  cream  and  water,  which  I  have 
known  to  be  an  excellent  substitute  for  the  bottle  on 
many  occasions,  we  have  the  mixture  suggested  by  Dr. 
J.  F.  Meigs  and  used  by  him  for  so  many  years  with 
success.1  A  two-inches  square  gelatin  cake  is  soaked 
for  a  short  time  in  half  a  pint  of  cold  water,  the 
water  is  then  boiled  for  fifteen  minutes  until  the  gelatin 
is  thoroughly  dissolved  ;  a  small  teaspoonful  of  arrow- 
root, rubbed  into  a  paste,  is  stirred  into  the  boiling 
water,  and  then  the  milk  added  in  the  proportion  of 
one-third  milk,  two-thirds  water  for  the  new-born, 
two-thirds  milk  and  one-third  water  at  six  months, 
varying  at  the  ages  between  in  proportion.      These  are 


1  Dr.  A.  V.  Meigs  recommends  the  following  way  of  preparing 
the  hottle :  Order  from  druggist  a  number  of  packages  of  sugar  of 
milk,  each  containing  seventeen  and  three-fourths  drachms ;  dis- 
solve one  of  these  packages  in  a  pint  of  water  each  day.  Take 
three  tablespoonfuls  of  this  sugar-water,  two  tablespoonfuls  of 
ordinary  cream,  one  tablespoonful  of  milk,  two  tablespoonfuls  of 
lime-water.     Put  in  nursing-bottle,  to  be  taken  warm. 


BOTTLE-FEEDING.  65 

allowed  to  boil  together  for  a  few  minutes,  and  then 
for  the  young  infant  two  tablespoonfuls  of  cream  are 
added  to  the  pint  of  food,  and  to  this  about  six  and  a 
half  drachms  or  teaspoonfuls  of  sugar  of  milk,  or  three 
teaspoonfuls  of  white  sugar. 

Lime-water  is  used  almost  universally  in  the  prepa- 
ration of  bottle-food,  both  with  the  object  of  making 
the  milk  slightly  alkaline,  and  for  the  purpose  of 
lessening  the  consistency  of  the  curd.  There  are  some 
children  with  whom  it  does  not  agree,  undoubtedly, 
but  as  a  rule  it  is  safer  to  use  this  form  of  alkali  than 
either  soda  or  potash,  because  lime-water  is  a  very 
weak  preparation,  and  there  is  no  danger  of  giving  too 
much  in  the  bottle,  which  certainly  would  be  the  case  if 
soda  or  potash  were  used  at  the  discretion  of  nurse  or 
mother. 

The  value  of  whey  as  a  substitute  for  milk  has  been 
advocated  by  many  writers  in  cases  where  the  child's 
digestion  is  weak  and  the  milk  curdles  in  large  masses 
and  very  readily,  or  in  cases  of  illness.  Whey  is  certainly 
an  admirable  substitute  for  the  ordinary  bottle.  It  can 
be  made  by  curdling  the  milk  with  rennet  and  strain- 
ing, and  according  to  Dr.  Eustace  Smith,  the  promi- 
nent English  authority,  it  can  be  given  to  a  child  in 
this  way : 

Two  tablespoonfuls  of  whey, 
Two  tablespoonfuls  of  hot  water, 
One  tablespoonful  of  fresh  cream, 
given  in  the  nursing-bottle. 


6* 


66  INFANCY. 


CHAPTER    IY. 

PKEPAEED   BOTTLE. 

Cow's  Milk,  its  Advantages  and  Disadvantages — A  Child's  Di- 
gestion— Different  Preparations  of  Bottle-Food — Why  an  Infant 
should  have  very  little  Starchy  Food  in  its  Diet — How  to 
avoid  either  Constipation  or  Diarrhoea — A  Baby's  Bottle  Diet 
may  be  varied — Peptonized  Milk— The  Care  which  a  Mother 
should  exercise  in  the  Selection  of  a  Child's  Diet. 

The  question  of  the  curd  commands  the  most  serious 
attention.  It  is  this  curd  that  is  always  in  the  way, 
although  it  is  an  important  article  of  diet,  as  it  is  a 
muscle- forming  element;  and  yet  it  is  not  the  most 
important  by  any  means  to  the  young  infant,  as  nature 
has  shown  by  supplying  so  little  to  the  human  milk 
compared  with  that  of  the  cow.  We  must  either  get 
rid  of  this  curd  entirely  for  children  who  are  suffer- 
ing from  disease  or  indigestion,  or  we  have  to  so  act 
upon  it  as  to  make  it  either  coagulate  in  flocculi,  or  to 
digest  it  in  the  bottle,  as  has  been  done  in  the  process 
called  peptonizing. 

The  whey-food,  or  a  mixture  of  cream  and  water, 
gives  us  a  preparation  without  the  curd  at  all,  or,  as 
in  the  latter,  very  little  of  it,  so  that  children  with  the 
weakest  digestions  can  probably  live  comfortably  and 
thrive  on  such  food;  but  of  course  when  it  comes  to 
growth  and  development,  requiring  active  muscular 
exercise,  a  stronger  food  is  needed,  and  casein,  or  curd, 
becomes  a  necessity.  I  will  quote  here,  for  the  informa- 
tion of  those  who  care  about  the  subject  of  digestion,  a 
portion  of  a  paper  recently  read  by  me.1 

Digestion  is  not  merely  a  process  of  disintegration  ; 
certain  secretions  are  requisite  to  bring  about  the  chemical 

1  Annals  of  Hygiene. 


PREPARED  BOTTLE.  67 

changes  required.  What  are  these  secretions  ?  First 
we  have  that  from  the  salivary  glands  which  changes 
starch  into  sugar.  The  saliva  secreted  by  a  child  under 
six  months  is  at  a  minimum ;  very  little  is  required, 
simply  enough  to  lubricate,  but  I  may  say  that  in  a 
series  of  experiments  I  have  recorded  a  child  of  seven 
days  who  secreted  saliva  which  possessed  sufficient 
diastase  to  convert 'the  boiled  starch  used  into  grape 
sugar.  This  readily  accounts  for  those  infants  who 
fatten  on  corn  starch,  much  to  the  surprise  of  the  family 
medical  attendant. 

As  the  child  grows  and  teething  begins,  quite  a 
large  amount  of  saliva  is  secreted,  and  undoubtedly  the 
activity  of  this  secretion  forms  a  prominent  part  in  its 
digestive  process ;  in  other  words,  a  child  that  slobbers 
as  a  rule  has  little  digestive  disturbance. 

From  birth  the  gastric  juice  takes  a  prominent  part. 
By  it  the  curd  is  precipitated  and  turned  into  peptones, 
or  albuminose.  All  albuminous  matter  is  so  converted, 
and  a  burden  by  no  means  light  is  placed  upon  the 
liver,  an  organ  more  prominent  in  infancv  than  in  adult 
life. 

The  precipitation  by  gastric  juice  of  the  casein  pre- 
sents some  curious  features  ;  indeed,  this  matter  is  of 
fundamental  importance  in  our  studies.  AYoman's  milk 
is  alkaline,  it  is  watery,  its  curd  is  precipitated  in  soft 
flakes.  Cow's  milk  is  slightly  acid,  its  curd  forms  in 
firm  hard  masses  of  cheesy  consistence.  Brush,  in  1879, 
told  us  that  the  curd  in  all  cud-chewing  animals,  of 
which  the  cow  represents  the  class,  was  thrown  down 
in  masses  so  as  to  be  readily  regurgitated  by  the  calf 
for  the  purpose  of  trituration.  In  the  non-cud-chewers 
the  reverse  is  the  rule.  There  may  be  other  peculiar- 
ities of  the  curd,  chemical  differences,  but  these  have 
not  as  yet  been  determined. 

The  secretion  from  the  pancreas  is  the  next  and  last 
of  importance.      It  is   composed    principally  of  two 


6g  INFANCY. 

materials,  in  fact  a  third  may  be  added,  the  curdling 
principle  ;  these  will  act  in  an  alkaline  or  faintly  acid 
solution  :  the  first  a  material  analogous  to  the  pepsin  of 
gastric  juice,  which  converts  casein,  or  other  albuminous 
matters,  into  peptones,  and  substances  that  have  es- 
caped the  action  of  the  gastric  juice;  and  a  diastase  like 
that  of  the  saliva,  which  converts  starchy  matters  and 
cane  sugar  into  dextrine  or  grape  sugar. 

To  the  infant  the  gastric  juice  is  the  most  important 
of  its  secretions  ;  only  such  food  as  contains  albuminous 
matter  with  soluble  carbo-hydrates,  as  glucose  and  oil  in 
emulsion,  should  be  given, — such,  indeed,  is  milk. 

We  have,  then,  two  matters  to  consider  in  the  arti- 
ficial feeding  of  infants,  and  I  shall  limit  myself  to 
those  within  the  first  year :  one,  the  preparation  of  a 
food  containing  the  elements  of  mother's  milk,  in  a 
combination  as  much  like  it  as  possible ;  and  the  other, 
no  less  important,  the  elaboration  of  those  secretions 
which  digest  it.  An  equal  balance  must  be  maintained 
between  the  two. 

The  coagulation  of  the  casein  of  cow's  milk  into  hard 
masses  can  be  prevented  by  certain  means;  one  of  the 
most  important  of  them  is  diluting  with  water.  It  is 
for  this  purpose  water  is  added  to  cow's  milk;  but  also 
it  has  been  noted  that  if  certain  materials  which  are  not 
digested  in  the  stomach  are  allowed  to  become  thor- 
oughly mixed  with  the  milk,  they  will,  acting  in  that 
way,  so  honeycomb  the  curd  as  it  were,  as  to  prevent 
its  forming  a  solid  lump  of  cheese.  Lime-water  may 
do  this, — if  the  bottle  is  shaken  there  is  a  good  deal 
of  lime  which  is  not  dissolved  in  it, — but  farinaceous 
food  such  as  the  cereals,  the  starches,  if  they  enter  the 
stomach  as  such,  are  not  digested  there,  but  probably 
act  in  a  measure  towards  the  curd  as  the  sand  does  in 
the  stomach  of  a  bird.  The  cereals  are  composed  of 
grains,  when  examined  under  the  microscope,  that  are 
covered  with  a  material  that  is  destroyed  by  heat  or 


PREPARED  BOTTLE.  69 

digested  by  the  gastric  juice;  the  starch  in  either  case 
becomes  free,  and  the  saliva,  if  it  comes  in  thorough 
contact  with  it,  will  turn  it  into  dextrine  or  grape  sugar ; 
in  that  state  it  is  carried  to  the  liver.  The  same  takes 
place  when  the  pancreatic  secretion  attacks  it, — that  is, 
after  the  food  has  left  the  stomach ;  but  as  a  child  has 
both  the  saliva  and  the  pancreas  secretion  in  a  small 
amount,  to  feed  it  entirely  on  starchy  food  is  simply  to 
give  it  starvation  diet.  It  cannot  live  on  such  material. 
Very  fortunately  for  the  baby,  its  corn-starch  has  to 
be  boiled,  and  this  boiling  process  partly  converts  it  into 
grape  sugar,  or  at  least  so  nearly  so  as  to  allow  the  contact 
of  the  feeblest  secretions  to  finish  the  work,  and  for- 
tunately, also,  nature  often  supplies  the  child  with  very 
active  salivary  glands  during  its  teething  period ;  it  slob- 
bers constantly,  and  the  corn-starch  food  comes  in  contact 
with  this  secretion,  that  renders  it  digestible ;  but  the 
poor  infant  who  is  given  half-boiled  arrow-root,  or  flour, 
or  corn-starch  too  thick  to  flow  readily  through  the  bot- 
tle, and  who  cuts  its  teeth  hard, — that  is  to  say,  has  dry 
gums,  little  secretion, — will  not  be  long  before  it  shows 
an  inflammation  of  the  bowels  that  will  be  the  cause 
of  its  death. 

The  reader  can  now  see  why  it  is  that  some  children  do 
get  along  well  on  corn -starch  food  and  thrive  from  a  very 
early  age  upon  boiled  bread  and  milk,  cracker-dust  food, 
or  substances  of  that  sort;  but  unfortunately  it  is  these 
very  children  who  form  exceptions  to  the  rule  that 
prove  the  invariable  evil  result  of  attempting  to  give 
starchy  food  to  two-thirds  of  the  children  too  young. 
An  amount  of  a  cereal  can  be  added  to  the  child's  bottle 
after  it  is  three  or  four  months  old,  if  it  is  deemed 
advisable,  beginning  with  a  very  small  quantity. 

Dr.  J.  Lewis  Smith  recommends  for  preparation  of 
infants'  food  the  following  plan  :  Take  from  five  to  ten 
pounds  of  well-selected  wheat  flour,  put  this  in  a  bag, 
tied  firmly,  and  allow  it  to  keep  covered  with  water  for 


70  INFANCY. 

several  days,  possibly  a  week,  and  this  should  occasion- 
ally be  made  to  boil.  In  the  preparation  of  the  bottle 
for  a  child  under  three  months,  the  water  used  for 
diluting  the  milk  can  have  boiled  with  it  some  of  this 
flour,  grated  in  the  proportion  of  two  heaping  teaspoon- 
fuls  to  a  pint ;  after  the  sixth  month  four  teaspoonfuls. 

The  milk  can  be  diluted  with  its  bulk  of  water, 
which  can  be  previously  thoroughly  boiled  with  either 
ground  barley,  oatmeal,  or  baked  flour,  in  the  propor- 
tion of  a  dessertspoonful  to  the  pint,  the  milk  poured 
in  while  the  water  is  boiling,  the  whole  boiled  together 
for  from  twenty  minutes  to  a  half-hour  at  least,  and 
then  strained.  This  can  be  sweetened,  an  ounce  of 
cream  added,  and  it  forms  an  excellent  food  for  a  child 
after  its  fourth  month. 

If  it  is  then  understood  that  the  addition  of  a  cereal 
such  as  barley,  oatmeal,  or  Graham  flour  is  not  to  be 
given  to  a  child  as  the  basis  of  its  food,  but  only  to 
slightly  thicken  the  milk  and  give  it  substance,  and 
to  prevent  heavy  curding,  the  choice  of  the  article  is 
a  matter  for  consideration  in  each  individual  case. 
Mothers  ought  to  know  that  the  outer  portion  of  the 
grain  of  wheat,  corn,  or  oats  acts  as  the  laxative, — 
in  other  words,  the  bran, — and  it  is  on  that  account  the 
crushed  grain  is  more  valuable  where  there  is  a  ten- 
dency to  constipation.  Next  in  order  to  the  outer  surface 
we  have  that  portion  of  the  grain  in  which  resides  most 
of  the  nitrogenous  principle,  the  so-called  gluten,  so  that 
in  the  debranned-flour  we  have  a  preparation  which  is 
nourishing  and  fattening,  but  is  not  laxative.  The 
internal  portion  of  the  kernel  of  all  these  cereals 
contains  the  starch-grannie,  and  this  part  we  know 
gives  the  tendency  towards  constipation.  When  it  is 
desirable  to  use  any  of  these  cereals  it  is  far  better 
to  use  the  whole  grain  crushed,  unless  there  should  be 
looseness  of  the  bowels  or  irritation  of  some  sort,  in 
which  case  the  flour  alone  should  be  used.    But  mothers 


PREPARED   BOTTLE.  71 

should  bear  in  mind  what  I  have  laid  stress  on  before, 
that  whenever  a  starchy  food  is  used  the  starch-granule 
should  be  thoroughly  broken  up  by  heat,  either  by  baking 
or  by  boiling.  This  is  an  essential  matter,  and  I  cannot 
repeat  it  too  often. 

When  a  mother  wishes  to  put  her  child  on  the  bottle, 
supposing  it  to  be  about  the  age  of  four  months,  and 
we  wish  to  add  something  to  the  bottle,  it  is  a  difficult 
matter  to  know  with  what  to  begin.  Dr.  J.  F.  Meigs 
advised  gelatin  and  arrow-root ;  Dr.  J.  Lewis  Smith,  of 
New  York,  advocates  the  flour  ball, — that  is  to  say,  the 
flour  tied  in  a  linen  rag  and  boiled  for  hours,  opened, 
and  the  interior  taken  out  and  grated  and  used  with 
the  milk.  My  own  preference  is  for  barley ;  it  is  the 
least  constipating,  and  usually  agrees  well ;  and  after 
the  child  has  become  accustomed  to  it  and  the  digestion 
is  in  good  condition,  a  small  amount  of  oatmeal  can  be 
added  with  each,  or  every  alternate,  bottle,  and  a  variety 
of  diet  in  that  way  instituted. 

Now,  in  preparing  the  barley  for  the  bottle  we  may 
either  take  the  whole-grain  pearl  barley,  and  have  it 
crushed  in  a  coffee-mill,  or  use  Robinson's  barley, 
which  comes  in  packages,  finely  powdered.  Of  course 
the  latter  is  easier  manipulated  and  requires  less  time 
to  prepare  it.  Of  the  powdered  barley,  take  a  dessert- 
spoonful, mix  it  into  a  smooth  paste  with  a  little  water, 
and  gradually  stir  this  into  a  pint  of  boiling  milk.  If 
the  child  is  under  six  months  of  age  you  can  then  add 
from  one-half  to  one-third  of  water,  and,  stirring  con- 
stantly, allow  the  mixture  to  boil  fully  twenty  minutes. 
To  this  can  be  added  a  heaping  teaspoonful  of  white 
granulated  sugar  and  a  pinch  of  salt.  It  should  then 
be  strained.  Now,  if  this  mixture  is  put  in  the  re- 
frigerator at  once  when  it  is  made,  in  the  morning,  it 
can  be  used  for  each  bottle  by  warming  over  and 
straining.  If  there  is  much  constipation,  oatmeal  or 
Graham  flour  (cracked  wheat)  can  be  used  in  the  same 


72  INFANCY. 

way.  A  variety  of  oatmeal  known  as  the  Bethlehem 
oatmeal  comes  powdered  for  this  purpose.  Of  course, 
if  the  coarser  grain  is  used,  the  boiling  process  will  have 
to  be  very  much  prolonged;  and  in  such  cases,  if  simply 
the  crushed  barley,  the  cracked  wheat,  or  the  ordinary 
oatmeal  is  made  use  of,  it  will  be  necessary  to  put  them 
to  boil  in  water  beforehand,  say  a  heaping  dessert- 
spoonful to  a  quart,  and  allowed  to  simmer  until  it  is 
boiled  down  one-half.  Then  this  can  be  added  to  the 
milk,  stirring  well,  and  either  both  boiled  together  for 
a  few  minutes,  or,  if  the  child  is  constipated,  simply 
scalding  the  milk  by  pouring  the  boiling  water  and 
meal  into  it,  stirring  it  meanwhile,  and  then  strain. 
The  sugar  and  salt  can  be  added. 

In  city  practice  I  always  recommend  the  boiling  of 
the  milk  for  precaution  sake,  and  I  think  the  tendency 
to  constipation  can  be  overcome  by  adding  cream  to  the 
bottle  and  by  giving  the  child  occasionally  a  bottle  of 
water,  which  it  will  readily  take.  It  is  important  to 
bear  in  mind  that  the  food  should  never  be  made  so 
thick  that  it  will  not  run  through  the  nipple.  The 
food  should  be  made  in  a  farina-boiler,  that  the  milk 
may  not  become  scorched. 

As  I  have  said,  the  selection  of  food  is  to  a  certain 
extent  an  experiment,  and  therefore  the  child  should 
be  watched  to  see  whether  it  exhibits  any  symptoms  of 
indigestion.  Regurgitation  of  food,  the  souring  of  it 
in  the  stomach,  flatulence,  hiccough,  nausea,  and  finally 
either  constipation  with  great  pain,  passage  of  curd, 
undigested  milk  which  has  a  disagreeable  odor,  white 
passages,  or  diarrhoea,  are  of  course  all  evidences  of  in- 
digestion, but  these  must  not  be  confounded  with  the 
symptoms  that  are  brought  about  by  tight  bandaging, 
jolting,  dancing  the  child  up  and  down  after  a  meal, 
forcing  it  to  take  more  food  than  it  can  conveniently 
carry  or  digest. 

I  have  often  seen  cases  in  which  the  mother  had 


PREPARED   BOTTLE.  73 

blamed  the  indigestion  on  the  diet  when  the  food  had 
agreed  perfectly  well,  but  the  indigestion  had  been 
brought  about  by  the  way  in  which  the  child  had  been 
treated.  If  the  child  uses  the  bottle,  it  should  not  lie  flat 
on  its  back,  but  should  assume  the  same  position  that 
it  occupies  when  nursing  from  its  mother.  It  is  well 
always  to  avoid  the  use  of  purgatives,  or  laxatives,  in 
bottle-fed  children  as  far  as  possible.  Use  in  their 
stead  the  more  laxative  cereals.  Remember  that  water 
is  nature's  most  efficient  laxative,  that  when  salt  is 
added  to  the  food  it  has  the  same  excellent  effect,  and 
that  regularity  and  the  establishment  of  habit,  both  in 
its  feeding  and  the  timely  movement  of  its  bowels,  is 
of  the  greatest  value  to  the  child.  Do  not  think  that 
it  is  the  amount  of  material  you  put  into  a  child's 
stomach  that  is  alone  necessary  for  its  sustenance.  Do 
not  think  that  because  a  child  is  given  a  quart  or  more 
of  milk  a  day  it  is  all  that  is  necessary,  and  that  it 
must  thrive  whether  or  not.  This  is  a  mistake  which, 
it  seems  to  me,  mothers  are  constantly  making.  It  is 
the  amount  that  is  digested  and  absorbed  that  nourishes, 
the  rest  decomposes  or  irritates. 

This  brings  us  to  the  subject  of  pre-digesting  the 
curd. 

Professor  Albert  R.  Leeds,  of  Hoboken,  gives  us  the 
following  way  of  preparing  milk  for  infants : 

One  gill  of  cow's  milk,  fresh,  unskimmed, 

One  gill  of  water, 

Two  tablespoonfuls  of  rich  cream. 
To  these  can  be  added  one  powder  which  contains  two 
hundred  grains  of  sugar  of  milk  and  four  grains  bicar- 
bonate of  soda,  with  a  grain  and  a  half  of  extract  of 
pancreas.  These  powders,  each  one  containing  the  above 
formula,  can  be  made  up  in  any  drug-store.  The  milk, 
with  this  powder  added  to  it,  should  be  put  in  a  nursing- 
bottle  and  placed  in  hot  water, — water  so  hot  that  it  can- 
not bear  the  hand  more  than  a  minute  at  a  time, — and 
d  7 


74  INFANCY. 

kept  there  for  about  twenty  minutes,  and  allowed  to  cool 
sufficiently  for  the  child  to  take.  This  powder  is  called 
Peptogenie  Milk  Powder. 

In  a  lecture  before  the  Philadelphia  Hospital  Nurses 
Training  School,  Mr.  Fairchild  spoke  as  follows  : l 

"  When  we  speak  of  peptonizing  food,  we  do  not 
mean  that  pepsin  is  employed  in  the  digestion  of  the 
food.  We  simply  mean  that  the  albuminous  portion, 
the  casein  of  milk,  for  instance,  is  converted  into  pep- 
tone. The  materials  used  for  the  purpose  are  the  fer- 
ments of  the  pancreatic  juice  in  the  form  of  a  powder, 
— the  extract  of  pancreas.2  This  contains  several  fer- 
ments, each  of  which  acts  on  a  different  form  of  food. 
The  conditions  under  which  these  ferments  act  are  very 
simple.  If,  in  attempting  to  digest  milk,  you  add  the 
ferment  to  the  milk  when  it  is  very  cold,  no  action  will 
be  obtained.  Again,  if  it  is  added  to  very  hot  milk,  no 
action  will  be  obtained.  The  conditions  under  which 
these  ferments  act  are  similar  to  those  found  in  the  body. 
A  good  test  for  determining  the  proper  temperature  of 
the  food  is  to  taste  it.  If  it  is  hotter  than  can  be  sipped 
with  ease,  it  is  too  hot.  If  it  is  desired,  a  little  ther- 
mometer may  be  employed  to  obtain  the  proper  tem- 
perature, which  is  100°  F. 

"  I  shall  now  show  you  how  to  make  peptonized 
milk.  I  take  one  of  these  l  peptonizing  tubes,'  which 
contains  five  grains  of  pancreatic  extract  and  fifteen 
grains  of  bicarbonate  of  soda,  and  empty  its  contents 
into  a  quart  bottle.  To  this  I  add  a  gill — that  is,  four 
ounces  or  eight  tablespoonfuls — of  cold  water,  and  if  it 
is  for  infant  feeding,  the  water  had  better  be  previously 
boiled.  Enough  may  be  boiled  in  the  morning  to  last 
all  day.  I  next  pour  into  the  bottle  a  pint  of  milk, 
and  shake  the  bottle  well.     By  adding  the  water  and 

1  Keported  by  Dr.  "William  H.  Morrison,  Holmesburg,  Pa. 

2  Or  the  "  essence  of  pancreas,"  or  the  "  liquor  pancreaticus. " 


PREPARED   BOTTLE.  75 

milk  cold,  we  run  no  risks.  Having  done  this,  the 
bottle  is  set  into  a  bowl  of  warm  water,  which  should 
be  of  such  a  heat  that  you  can  hold  your  hand  in  it  for 
a  minute ;  the  temperature  of  the  milk  is  thus  raised 
to  about  100°.  The  milk  is  allowed  to  remain  in  the 
water  for  half  an  hour;  it  is  then  put  upon  the  ice, 
and  the  digestion  will  still  continue  for  some  time, — 
until  the  milk  is  thoroughly  chilled,  after  which  no 
further  digestive  change  can  take  place. 

"  I  have  here  a  bottle  of  milk  which  has  been  di- 
gested in  this  way.  I  have  allowed  the  digestion  to 
be  carried  a  little  further  than  is  usually  necessary,  in 
order  that  I  might  show  you  the  properties  of  pepton- 
ized milk.  I  first  take  ordinary  milk  and  add  an  acid 
to  it.  At  once  a  mass  of  coagulated  casein  falls  to  the 
bottom  of  the  glass.  I  treat  a  sample  of  peptonized 
milk  in  the  same  way,  and  there  is  no  trace  of  casein. 
As  I  have  said,  it  is  not  usually  necessary  to  digest  all 
the  casein,  and  the  directions  which  I  have  given  are 
for  average  cases.  You  have  to  observe  the  eifect  of 
the  milk  on  the  patient's  digestion.  If  it  is  assimilated 
readily,  the  proper  pre-digestion  has  been  secured  ;  but 
if  it  is  necessary  to  digest  it  still  further,  the  milk  may 
be  allowed  to  remain  longer  in  the  hot  water.  If  the 
milk  has  been  digested  too  much,  and  is  a  little  bitter, 
it  may  be  made  agreeable  by  the  addition  of  a  little 
sugar.  You  will  soon  learn  by  experience  how  to 
adapt  the  process  to  the  requirements  of  each  case. 

"  Instead  of  using  plain  water,  we  may  take  a  quan- 
tity of  starch  paste,  add  a  little  pancreatic  extract  to  it, 
and  stir  it  up.  When  starch  is  boiled  it  simply  swells 
up,  but  within  a  few  minutes  after  the  addition  of  the 
pancreatic  extract  it  becomes  a  thin  liquid  from  the 
digestion  of  the  starch, — by  the  pancreatic  diastase ; 
this  starch  is  now  in  the  way  of  being  converted  into 
glucose  or  grape  sugar.  This  may  be  put  into  a  bottle 
with  the  soda  and  milk;  and  digested  in  the  manner 


76  INFANCY. 

just  shown,  and  we  shall  have  peptonized  milk  gruel. 
Here  the  nutritious  elements  of  the  starch  are  added  to 
the  milk.  In  using  the  peptonizing  powder  a  little  water 
is  always  used  to  dilute  the  milk,  otherwise  it  would  be 
slightly  curdled  by  the  extract  of  pancreas. 

"This  peptonized  milk  can  readily  be  made  into 
lemonade.  It  may  strike  you  as  rather  odd  to  add 
lemon-juice  to  milk,  but  as  the  milk  has  been  com- 
pletely peptonized,  it  will  not  curdle,  and  the  lemon  is 
often  desirable  to  make  the  milk  pleasant.  Rum  and 
sugar  may  be  added  if  stimulants  are  required,  making 
a  delicious  punch.  It  may  also  be  taken  with  carbonic 
acid  water,  and,  if  thought  necessary,  lime-water  may 
be  added,  although  Ave  have  already  added  an  alkali. 

"  You  may  make  a  peptonized  milk  jelly.  If  you 
wish  to  make  a  jelly,  it  is  necessary  to  allow  the 
digestion  to  progress  for  a  longer  time.  A  pint  of 
peptonized  milk  is  heated  to  the  boiling-point, — that  is, 
you  scald  the  milk.  This  is  necessary  to  destroy  the 
ferment.  Then  take  three-fourths  of  an  ounce  of 
Coxe's  gelatin,  a  tablespoonful  of  lemon-juice,  and  a 
couple  of  tablespoonfuls  of  orange-juice.  When  the 
milk  is  scalded  some  of  the  lemon  and  orange-peel  may 
be  scalded  with  it,  which  gives  a  fresh  flavor  of  the 
peel.  The  gelatin  is  then  added,  and  wine,  brandy,  or 
St.  Croix  rum  may  also  be  added.  If  you  do  not  re- 
member to  scald  the  milk,  you  will  not  get  a  jelly,  for 
the  extract  of  pancreas  will  not  only  digest  the  casein, 
but  it  will  also  digest  the  gelatin. 

"  In  digesting  meat,  take  two  tablespoonfuls  of 
chicken  or  beef  finely  minced  and  boil  it  with  a  gill  of 
water.  This  makes  the  meat  soft  and  facilitates  its 
digestion.  The  meat  is  then  rubbed  into  a  fine  pulp  and 
put  back  into  the  water.  You  may  now  add  a  gill  of 
the  starch  mucilage  and  one  of  the  peptonizing  powders. 
It  is  then  set  aside  for  two  or  three  hours,  and  at  the 
end  of  that  time  scalded.     The  peptonized  soup  may  be 


PREPARED   BOTTLE.  77 

seasoned  to  suit  taste.  The  scalding  is  necessary  to 
stop  the  digestion,  which  otherwise  would  go  on  and 
lead  to  but  refractive  changes. 

"  This  plan  may  be  used  with  ordinary  soup.  Take 
two  or  three  tablespoon fuls  of  the  meat,  barley,  etc., 
strained  from  soup,  rub  it  to  a  pulp,  and  add  fifteen  or 
twenty  grains  of  pancreatic  extract  and  half  a  drachm 
of  bicarbonate  of  soda ;  add  to  a  pint  of  the  soup,  and 
proceed  as  just  shown.  There  is  no  doubt  that  you  get 
artificial  digestion  of  all  the  substances,  and  at  the  same 
time  you  have  no  more  trouble  than  in  making  ordinary 
food.  If  this  is  strained,  and  gelatin  added,  you  ob- 
tain a  nice  clear  jelly.  The  peptonized  milk  jelly  is 
more  agreeable  than  those  made  with  ordinary  milk. 

"  In  preparing  peptonized  milk  for  babies,  we  follow  a 
little  different  plan.  In  using  cow's  milk  we  have  to 
dilute  it  with  an  equal  quantity  of  water  in  order  to  ob- 
tain the  proper  amount  of  casein.  We  have  to  add  a  small 
quantity  of  milk  sugar  to  make  up  for  that  lost  by  the 
dilution  with  water,  because  mother's  milk  contains  a 
little  more  sugar  than  cow's  milk.  Then  we  have  to  add 
the  alkaline  salts  which  are  found  in  human  milk.  Dr. 
Keating  spoke  of  the  acidity  of  cow's  milk,  and  this  is 
a  point  which  few  people  properly  appreciate.  Testing 
this  sample  of  milk  with  litmus-paper  it  is  found  to  be 
distinctly  acid,  and,  in  fact,  I  have  never  tested  cow's 
milk  without  finding  this  acid  reaction.  Here  we  have 
a  powder  (peptogenic  milk  powder)  which  presents  the 
proper  proportion  of  milk  salts,  milk  sugar,  and  the 
digestive  ferment  to  change  the  casein  into  the  soluble 
form  in  which  the  albuminoids  exist  in  mother's  milk. 
I  take  four  ounces  of  milk,  add  the  proper  amount  of 
the  peptogenic  milk  powder;  next  we  add  four  ounces 
of  water  and  two  tablespoonfuls  of  cream.  This  latter 
is  an  important  element,  for  mother's  milk  contains 
more  fat  than  cow's  milk.  In  this  way  we  obtain 
the  same  proportions  of  the  different  elements  as  are 

7* 


78  INFANCY. 

found  in  human  milk.  All  that  is  now  required  is  to 
heat  it  to  the  proper  temperature  for  five  or  six  minutes 
in  order  to  properly  modify  the  casein.  The  temperature 
is  to  be  determined  as  in  the  former  case  by  sipping  or 
by  the  use  of  the  thermometer.  In  this  process,  having 
first  made  a  milk  mixture  which  contains  the  right 
quantity  of  all  the  elements  of  mother's  milk,  and  with 
its  peculiar  alkaline  character,  then  we  seek  to  effect 
just  such  a  change  of  the  casein — the  '  curd' — as  will 
present  it  to  the  infant's  stomach  in  the  condition  fit  for 
digestion,  in  such  a  condition  that  it  will  behave  in  the 
stomach  just  as  mother's  milk  does,  and  make  the  same 
demand  upon  the  natural  digestive  functions.  If,  how- 
ever, the  baby  is  very  ill,  and  not  even  capable  of  di- 
gesting its  natural  food,  this  method  allows  you  to 
digest  it  still  further. 

"  There  are  two  other  ways  in  which  the  '  humanized' 
milk  may  be  prepared.  Instead  of  taking  the  quantity 
of  milk  which  I  have  done,  we  may  take  a  larger  quan- 
tity and  a  proportionately  larger  quantity  of  the  other 
ingredients,  mix  them,  and  keep  them  on  ice.  There 
will  be  no  action  as  long  as  the  low  temperature  is  con- 
tinued. The  proper  amount  may  be  poured  out  and 
heated  whenever  it  is  required. 

"  The  other  way  is  to  make  the  mixture  as  just  de- 
scribed, and  stand  it  in  warm  water  for  fifteen  minutes. 
This  will  give  the  proper  amount  of  digestion.  Then 
scald  it ;  this  kills  the  ferment,  and  the  milk  can  be 
kept  with  no  more  care  than  ordinary  milk.  You  can 
then  take  the  proper  amount  and  warm  when  it  is 
needed,  and  you  have  no  further  trouble  with  it.  For 
asylums  where  there  are  many  children,  this  is  probably 
the  best  way.  This  gives  us  milk  which  is  as  exact  an 
imitation  of  the  natural  milk  of  the  mother  as  we  can 
expect  to  obtain  it  in  practice." 

The  extract  of  pancreas  can  be  obtained  at  any  drug- 
store, and   is   at   present  highly  recommended   by  all 


PREPARED  BOTTLE.  79 

physicians  in  this  country  and  Europe  when  prepared 
according  to  the  directions  just  given,  for  infants  who 
are  suddenly  deprived  of  mother's  milk  or  for  those 
that  are  sick.  A  certain  amount  of  care  is  required  in 
the  preparation  of  this  food,  because  if  the  peptonizing 
process  goes  on  too  long  the  milk  will  become  bitter 
and  the  child  will  refuse  it ;  if  it  does  not  go  on  long 
enough,  the  curd  of  course  will  not  be  affected.  I 
think  on  this  account  it  is  considered  troublesome,  and, 
in  institutions  especially,  condensed  milk  appears  to  have 
the  greater  number  of  advantages.  There  is  another 
quality  which  the  extract  of  pancreas  possesses  which 
is  as  important  as  that  of  the  digestion  of  casein,  which 
is  that  a  small  quantity  of  it  when  added  to  the  broken 
starch -granule  will  aid  in  converting  it  into  grape  sugar 
and  thereby  render  it  digestible ;  for  instance,  if  a  child's 
bottle  be  made  up  of  barley-water  and  milk  or  oatmeal, 
a  few  drops  of  the  extract  of  pancreas  in  solution  will 
render  certain  its  digestibility.  And  for  children  who 
have  a  tendency  to  diarrhoea,  or  with  whom  starchy  food 
fails  to  agree,  this  can  be  made  use  of. 

This  brings  us  to  another  subject.  Anything  which 
will  convert  the  cereals  into  grape  sugar  before  the 
food  is  taken  to  the  child,  will  aid  in  nutrition. 
Why?  Because  these  cereals  not  only  contain  starch, 
which  goes  to  supply  fat  and  heat,  but  they  also 
contain  albuminoids,  as  gluten  and  other  nitrogenous 
materials,  which  go  to  the  formation  of  muscular  tissue, 
and  salts,  which  are  bone-forming.  If  the  whole 
grain  can  be  so  prepared  as  to  be  perfectly  digested,  a 
great  deal  will  have  been  gained  in  the  nutrition  of  the 
child,  and  for  this  object  various  foods  have  been  sug- 
gested. A  substance  which  converts  starch  into  sugar  is 
diastase,  or  malt.  Each  granule  of  the  cereals  possesses 
a  certain  ferment  which,  if  allowed  to  develop  by  heat 
and  moisture,  will  turn  the  starch  into  sugar.  This  is 
made  use  of  in  the  preparation  of  food  for  children, 


80  INFANCY. 

such  as  Liebig's  foods,  where  the  starch  has  been 
turned  into  grape  sugar  by  malting.  Mellin's  food 
and  Horlick's  food  are  prepared  on  the  same  principle. 
These  foods  are  nothing  more  than  malted  grain.  It 
is  a  fat-making  and  nourishing  food,  which  when  taken 
into  the  stomach  will  increase  the  nutrition  of  the  body 
and  store  up  a  certain  amount  of  fat,  and  valuable  be- 
cause it  requires  very  little  digestion.  The  child  at 
birth,  however,  requires  simply  milk  of  the  character 
which  nature  presents.  It  needs  no  more  albumen  and 
no  more  sugar.  What  we  want  is  to  supply  a  milk  as 
nearly  as  possible  of  the  quality  furnished  by  nature. 
It  is  therefore,  in  my  opinion,  not  necessary  to  add 
Mellin's  or  Horlick's  food  to  the  milk  of  children  at 
birth.  All  that  we  need  is  a  milk  which  will  be 
digested  and  readily  absorbed. 

Any  preparation  of  malt  that  will  aid  the  digestion 
of  starchy  food  is  useful,  not  only  for  adults  who  suffer 
from  flatulence  and  debility  of  the  digestive  organs,  but  it 
is  also  good  for  infants,  when  given  in  moderation ;  and 
when  I  advise,  as  a  rule,  mothers  to  avoid  these  prep- 
arations for  their  very  young  babies,  I  am  only  speak- 
ing of  healthy  children.  This  leads  me  to  the  question 
of  those  foods  in  addition  to  the  child's  bottle  which 
either  aid  in  the  digestibility  or  are  themselves  of  value 
in  supplying  nourishment.  According  to  Professor 
Leeds,  of  Hoboken,  these  classes  of  foods  may  be 
divided  into  the  milk  foods,  the  farinaceous  foods,  and 
the  IAebig  foods.  I  give  many  of  the  different  prepara- 
tions under  these  headings,  in  order  that  the  mother 
can  intelligently  make  her  choice,  should  one  not  agree 
with  her  child. 

I  have  said  before,  and  I  may  repeat  it  here,  as  it  is 
a  very  important  matter,  that  the  choice  of  a  food  for 
a  child  is  a  matter  of  experiment,  for  what  agrees  with 
one  may  not  agree  with  another,  even  in  the  same  fam- 
ily ;  that  the  test  of  whether  or  not  a  food  agrees  with 


PREPARED   BOTTLE.  81 

a  child  is  if  the  child  thrives  upon  it, — if  it  sleeps  well, 
its  flesh  becomes  firm,  its  digestion  is  good,  its  temper  is 
amiable, — because  a  cross  child,  in  nine  cases  out  of  ten, . 
is  either  a  dyspeptic,  or  a  sickly  one.  These  tests  are 
the  only  ones  that  are  of  value,  notwithstanding  the 
advertisement  that  such  and  such  foods  are  the  only 
ones  that  agree  with  the  baby.  Should  a  child  be  lan- 
guid, drooping,  appear  weak,  and  not  thrive,  one  of 
the  milk  foods — such  as  Nestle' s,  pre-eminently — would 
be  a  useful  addition  to  its  food,  or  it  can  be  used  simply 
with  water,  as  it  contains  condensed  milk,  also  Carn- 
rick's  Soluble  Food  can  be  advised  in  this  way.  As 
the  child  grows  older,  a  farinaceous  food  may  be  given 
in  the  way  described  on  page  71.  Should  the  passages 
become  constipated  and  there  be  much  flatulence,  the 
child  suffer  from  colic,  become  restless  at  night,  lose  its 
appetite,  then  the  change  should  be  made  to  one  of  the 
Liebig  foods,  and  in  this  way  its  digestion  encouraged 
and  nutrition  established.  An  intelligent  mother  watch- 
ing carefully  her  child  can  thus  be  guided  in  the  choice 
of  its  food ;  but  it  should  be  always  borne  in  mind  that 
as  milk  contains  all  of  the  elements  for  nutrition  in  such 
proportion  as  is  required,  those  foods  which  are  not 
milk  foods  should  always  be  made  up  with  milk  in  the 
preparation  of  the  bottle;  and  if  fresh  cow's  milk  cannot 
be  obtained  for  this  purpose,  a  milk  food  well  diluted 
should  be  used,  such  as  ordinary  condensed  milk, 
Borden's  or  Canfield's  fresh  evaporated  milk,  or  one  of 
the  milk  foods  given  in  the  table : 

MILK   FOODS. 

Nestle's, 

Carnrick's  Soluble  Food, 

Anglo-Swiss, 

Gerber's, 

American  Swiss,  and  others. 


82  INFANCY. 


FARINACEOUS  FOODS. 

Blair's  Wheat, 

Hubbell's  Wheat, 

Imperial  Granum, 

Hard's  Food, 

Ridge's  Food, 

Robinson's  Patent  Barley, 

Bethlehem  Oatmeal,  and  others. 

LIEBIG  FOODS. 

Mellin's, 

Horlick's, 

Lactated  Food, 

Hawley's, 

Keasby  &  Mattison's, 

Savory  &  Moore,  and  others. 

Frequently  a  child  may  be  so  weak  or  exhausted  from 
disease  or  from  inanition  that  food  of  the  mildest  char- 
acter will  not  remain  on  its  stomach.  It  would  be  use- 
less to  keep  on  diluting  condensed  milk,  as  it  would 
render  it  valueless.  In  cases  of  this  sort,  the  white  of 
an  egg  shaken  np  in  a  bottle  of  warm  water  to  which  a 
couple  of  grains  of  lactopeptine  is  added,  sweetened 
and  given  by  the  bottle  if  the  child  will  nurse,  and  by 
spoon  in  small  amounts  if  the  child  will  not,  is  very 
nourishing.  Wine-whey  can  be  given  in  the  same 
manner.  Gum-arabic  water  will  nourish  for  a  surpris- 
ingly long  time,  and  allay  irritability  of  the  stomach 
and  bowel,  and  finally  the  child  can  be  gradually 
encouraged  to  take  small  and  repeated  quantities  of 
peptonized  milk  or  one  of  the  milk  foods. 


WEANING.  83 

CHAPTER  V. 

WEANING. 

"Weaning — When  to  wean  a  Child — Where  to  wean  a  Child ;  and 
how  to  wean  it. 

The  question  is  often  asked,  At  what  age  should 
weaning  begin  provided  that  there  is  no  immediate 
necessity,  and  how  should  the  process  be  managed? 
It  greatly  depends  on  the  family  arrangements  for 
spending  that  season  of  the  year  which  in  this  part  of 
the  world  is  most  to  be  dreaded,  the  summer.  Of  course, 
if  a  child  is  to  be  taken  to  the  sea-shore,  or  some  cool 
summer  resort,  where  milk  can  be  supplied  fresh  and 
abundant,  the  question  of  weaning  in  the  summer-time 
has  not  half  the  importance  attached  to  it  as  it  has  to 
those  who  are  obliged  to  spend  the  summer  in,  or  near, 
one  of  our  large  cities.  My  own  opinion  is  that  if  a 
child  has  been  nursed  for  four  months,  certainly  for  six 
months,  the  gradual  addition  to  its  dietary  of  a  bottle 
will  be  of  advantage.  I  have  studied  this  matter  con- 
siderably of  later  years,  and  somewhat  modified  my 
former  views  on  the  subject,  and  my  own  investigation 
and  those  of  others  have  recently  confirmed  them,  that 
a  child,  partly  nursed  and  partly  bottle-fed,  after  its 
fourth  month,  thrives  better  than  one  bottle-fed  alone, 
— that,  in  fact,  breast-milk  helps  to  make  the  bottle 
more  digestible.  Not  only  is  this  the  case,  but  I 
believe  that  it  is  a  great  relief  to  the  mother,  gives  her 
more  time  to  rest,  is  less  drain  upon  her  nutrition,  and 
it  also  is  of  importance  should  the  child  be  obliged  to 
take  the  bottle,  either  because  the  mother's  milk  gives 
out,  she  becomes  pregnant,  or  her  health  gives  way;  but 
I  certainly  think  that  four  months  is  young  enough, 
provided  the  mother's  milk  is  found  to  be  of  good 


84  INFANCY. 

quality,  nourishing,  and  the  child  thrive  upon  it. 
Should  this  not  be  the  case,  the  addition  to  nursing  by 
an  occasional  bottle  will  have  a  tendency  to  concentrate 
the  breast-milk,  making  it  more  nourishing,  and  thus 
avoid  the  necessity  of  weaning  altogether. 

For  a  child  that  is  born  as  late  as  January  or  Feb- 
ruary I  should  not  recommend  the  addition  of  any 
bottle  food  until  the  following  October,  provided  the 
mother  is  able  to  nurse  it.  For  a  child  born  in  October 
or  November,  and  especially  when  the  following  sum- 
mer can  be  spent  out  of  town  or  at  the  sea-shore,  the 
weaning  process  could  possibly  be  all  over  by  May. 
If  a  mother  is  strong  and  hearty,  has  no  consumption 
in  the  family,  has  plenty  of  milk,  and  is  not  in  the 
least  pulled  down  by  nourishing  her  baby,  if  she  can 
nurse  it  a  year  I  think  it  so  much  the  better,  and  for 
the  last  four  months  her  child  can  take  some  bottle  food 
in  addition.  I  do  not  think  any  mother  should  nurse 
her  child  for  more  than  a  year ;  there  is  no  necessity  for 
it  as  a  rule.  The  milk  is  not  sufficiently  nourishing, 
and  unless  it  is  supplemented  by  the  bottle  the  chances 
are  that  the  child  will  become  sickly.  Indeed,  a  good 
strong  healthy  child  that  becomes  accustomed  to  the 
bottle  food  will  wean  itself  before  that  time  is  up,  and 
this  is  exactly  what  we  wish  a  child  to  do, — to  wean 
itself.  Now,  in  the  gradual  process  of  weaning  or  the 
addition  of  a  bottle  to  its  regular  nursing,  the  babe 
of  five  or  six  months  may  take  its  food  according  to  the 
following  programme :  It  should  nurse  from  its  mother 
in  the  morning,  six  or  seven,  and  then  after  its  bath 
take  a  bottle  about  half-past  ten  or  eleven  o'clock ; 
possibly  nurse  from  its  mother  about  one  or  two 
o'clock ;  again  a  bottle  at  five  or  six ;  and  then  the 
mother  should  nurse  it  at  retiring  at  ten  or  eleven. 
In  this  way  it  becomes  gradually  accustomed  to  the 
bottle  at  the  time  of  day  when  it  is  most  apt  to  agree. 
It  gives  the  mother  an  opportunity  to  take  exercise  and 


WEANING.  85 

rest.     Possibly  it  may  need  a  bottle  about  four  o'clock 
in  the  morning. 

The  question  would  be  asked,  What  should  be  the 
first  choice  when  selecting  the  bottle  food  of  a  child  at 
this  age  ?  I  would  recommend  that  the  bottle  be  pre- 
pared with  barley,  or  Imperial  Granum,  cracker-dust, 
or  grated  flour  ball,  and  add  in  increasing  quantities, 
beginning  probably  with  a  small  teaspoonful,  Mellin's 
or  Horlick's  food.  As  the  child  grows  older,  the  mid- 
day bottle  can  be  varied.  I  believe  that  by  using  a 
mixture  of  the  cereals  we  often  get  a  more  palatable  and 
more  nutritious  preparation  than  by  using  them  singly  ; 
thus,  oatmeal  and  barley,  or  Graham  flour,  can  be  used 
together,  or  oatmeal  and  Hubbell's  food.  The  child  will 
show  a  decided  preference  for  some  kind  of  bottle  food, 
but  bear  in  mind  that  it  is  a  great  mistake  to  stutf  a 
child.  A  mother  will  often  be  tempted  to  add  a  little 
more  oatmeal,  or  Mellin's  food,  etc.,  thinking  that  a 
little  increase  will  make  her  baby  stronger  and  rosier. 
This  is  true  if  the  child  lives  in  the  country  or  at  the 
sea-shore,  where  it  is  out  of  doors  all  day  long,  in  a 
cool  bracing  climate,  especially  if  it  is  able  to  run  about ; 
but  if  mothers  could  see,  as  doctors  do,  the  numbers 
of  sluggish,  heavy  children  that  our  cities  afford,  with 
coated  tongues  and  heavy  breaths,  and  constipation,  who 
are  fairly  packed  with  baby  foods  and  all  the  most 
concentrated  articles  of  diet  that  modern  chemistry 
presents  us  with,  they  would  understand  why  it  is  that 
the  ill-fed,  ill-clothed  children  of  the  poor,  who  live  on 
a  crust  and  digest  it,  are  so  much  more  able  to  resist 
disease  than  their  own.  It  is  on  this  account  I  be- 
lieve that  although  oatmeal  is  a  most  valuable  addi- 
tion to  the  diet,  it  should  only  be  used  in  small  amounts, 
should  be  thoroughly  boiled,  the  children  when  taking 
it  kept  out  of  doors  as  much  as  possible,  and  it  should 
not  be  used  in  hot  weather,  nor  with  children  who 
have  what  is  called  a  "  bilious  tendency." 


86  INFANCY. 

If  fresh  cow's  milk  is  not  obtainable,  condensed  milk 
can  be  used  in  this  gradual  weaning  of  children.  Let 
me  here  say  again  that  when  we  use  any  substance  be- 
sides milk  in  its  bottle,  such  as  the  cereals,  we  should 
not  forget  that  the  child  needs  water — pure,  clean  water 
to  drink.  Very  often  a  child  that  is  partly  bottle  fed 
and  partly  nursed  is  restless  at  night,  will  not  sleep. 
Instead  of  the  mother's  trying  to  put  it  to  sleep  by 
nursing  it,  if  she  would  simply  give  it  some  water  in 
its  bottle,  or  possibly  a  little  Mellin's  food  in  the  water, 
it  would  go  to  sleep  and  not  run  the  risk  of  indigestion 
from  over-feeding. 

Bear  in  mind  that  in  the  summer-time  if  a  child 
takes  more  food  than  it  can  digest,  this  food  is  apt  to 
decompose,  act  as  an  irritant,  and  possibly  give  rise  to 
an  inflammation  that  will  end  in  summer  complaint. 
Suppose,  then,  that  a  child  has  been  weaned  from  the 
breast,  and  the  object  now  is  to  gradually  take  it  off  the 
bottle  or  give  it  some  additional  food  besides  that  which 
it  takes  in  its  bottle.  We  may  presume  that  its  bottle 
has  been  agreeing  with  it,  but  that  for  the  last  few 
weeks  it  has  turned  against  it,  as  it  were, — it  seems  to 
crave  more  solid  food.  Certainly  by  the  time  it  is 
twelve  months  old  it  could  very  well  be  given  a  small 
cupful  of  chicken-broth  or  beef-soup.  Possibly  before 
this  time  it  has  been  given,  instead  of  the  usual  bottle 
after  waking  from  its  mid-day  nap,  some  boiled  bread 
and  milk ;  and  now,  instead  of  bread  and  milk,  some 
chicken-broth,  with  a  little  dry  toast  soaked  in  it,  can 
take  the  place  of  this  meal,  and  the  bread  and  milk  be 
given  for  supper  about  six  o'clock.  In  this  way  the 
"  bill  of  fare"  for  three  meals  can  be  gradually  mapped 
out,  and  the  child  permitted  to  masticate  part  of  its 
food ;  this  will  aid  the  cutting  of  the  teeth  as  well  as 
increase  its  digestion.  When  a  child  takes  bread  and 
milk  in  this  way  it  is  always  well  to  let  it  have  an 
occasional  drink  of  plain  milk. 


FRESH  AIR,  VENTILATION,  OUT-DOOR  EXERCISE.  87 


CHAPTER  VI. 

FEESH  AIE,  VENTILATION,  OUT-DOOE  EXEECISE. 

The  Great  Importance  of  Ventilation — The  Selection  and  Care  of 
the  Nursery — How  it  should  be  Heated — The  Danger  of  allow- 
ing Children  to  be  left  to  the  Care  of  Young  and  Inexperienced 
Girls — How  Children  frequently  contract  Diseases. 

There  are  a  great  many  facts  that  have  been  given 
us  by  scientific  men  that  should  be  applied  to  every-day 
custom  ;  among  these  none  more  important  than  those 
relating  to  the  subject  of  ventilation,  by  which  we  mean 
the  getting  rid  of  foul  air  and  the  entrance  of  pure  air 
in  as  easy  a  manner  as  possible,  free  from  draughts. 
We  all  kuow  that  the  passage  of  cold  air  through  a 
chink,  when  striking  against  some  sensitive  nerve-point 
on  the  surface  of  the  body,  which  is  exposed,  will  have 
a  peculiar  way  of  abstracting  heat,  or  give  what  is 
known  as  "  a  cold,"  affecting  the  mucous  membranes. 
Of  course,  the  more  delicate  or  the  younger  the  indi- 
vidual the  more  susceptible  it  would  be  to  such  an  im- 
pression. There  are  certain  parts  of  the  body  more 
susceptible  to  these  currents  of  cold  air ;  these  are  the 
face,  neck,  and  feet ;  neuralgia,  sore  throats,  and  colds 
in  the  head  being  the  consequence.  But  it  is  to  be  ob- 
served that  these  draughts  are  more  apt  to  make  them- 
selves felt  when  the  parts  on  which  they  strike  are  in  a 
state  of  relaxation ;  naturally,  should  there  be  perspira- 
tion, its  evaporation  would  intensify  the  cold  impres- 
sion. When  children,  then,  after  active  play,  perspiring 
freely,  sit  in  a  room  in  a  draught,  they  will  take  cold, 
and  at  the  same  time  they  might  continue  their  play  in 
a  colder  room,  and  not  feel  it ;  the  action  of  their  mus- 
cles, the  excitement,  will  give  them  resistance  which 


88  INFANCY. 

they  would  not  have  in  a  state  of  quiet.  It  should  be 
our  object,  then,  in  the  choice  of  a  nursery,  to  have  a 
room,  or  two  rooms  communicating  (when  speaking 
of  these  matters  I  specially  refer  to  our  city  nouses), 
as  far  removed  as  possible  from  the  contaminations  and 
the  filth  of  the  streets.  The  play-room  should  be  large, 
certainly,  situated  in  the  second  or  third  story,  and 
should  have  the  sun  in  it  at  least  part  of  the  day. 

Of  course,  for  a  few  weeks  the  new-born  babe  will 
sleep  with  its  mother ;  if  it  is  a  strong  and  vigorous 
child  it  can  be  placed  in  a  crib  or  bassinet  by  her  side. 
The  great  objection  to  placing  the  child  away  from 
the  mother  is  that,  after  the  nurse  leaves,  she  would 
have  to  reach  for  it,  and  if  her  room  is  cooler  at  night, 
as  it  should  always  be,  there  will  be  great  danger  of 
her  taking  cold  when  she  nurses  the  baby.  On  this 
account,  the  child's  crib  should  be  placed  as  near  as 
possible  to  the  mother's  bed,  or  she  should  manage  to 
allow  it  to  sleep  in  the  bed  with  her,  but  so  arranged 
that  it  will  have  a  portion  of  the  bed  entirely  to  itself. 
The  child  is,  certainly,  after  a  couple  of  months,  health- 
ier when  sleeping  alone. 

For  the  first  month,  at  least,  after  birth,  while  the 
nurse  is  still  with  the  mother,  she  should  take  charge 
of  the  infant  and  bring  it  in  to  nurse  at  the  proper 
hour.  The  choice  of  a  nursery  and  sleeping-apartment 
is  a  matter  of  great  importance.  The  essentials  are, 
purity  of  atmosphere  and  uniformity  of  temperature, 
freedom  from  dust  and  gases  which  may  arise  from 
methods  of  heating;  especially  is  this  the  case  with 
faulty  hot-air  furnaces.  There  should  be  plenty  of 
sunshine  when  possible.  At  the  present  day,  with  our 
extended  knowledge  of  the  cause  of  disease,  impurity 
in  the  atmosphere  has  assumed  great  importance ;  we 
are  now  able  to  recognize  the  fact  that  certain  diseases 
which  we  hitherto  attributed  to  cold  are  in  reality  due 
to  filth  ;  that  certain  other  intestinal  disturbances,  which 


FRESH  AIR,  VENTILATION,  OUT-DOOR  EXERCISE.  89 

were  attributed  to  heat,  are  in  reality  due  to  decomposed 
or  fermented  food  ;  these  facts  are  most  important  for 
us  to  bear  in  mind,  not  only  to  enable  us  to  cure  dis- 
ease, but  also  because  by  a  thorough  recognition  of  them, 
these  diseases  or  disorders  which  have  been  attributed 
to  climacteric  disturbances  may,  by  the  timely  institu- 
tion of  hygienic  measures,  be  avoided.  There  is  no 
reason  why  a  child  that  has  a  well-ventilated,  clean, 
bright  nursery,  whose  milk  is  watched  with  zealous 
care  and  never  allowed  to  be  tainted,  one  who  is  daily 
bathed,  not  overfed,  neither  debilitated  by  too  heavy 
clothing  nor  subjected  to  daily  fluctuations  in  bodily 
temperature,  should  not  pass  through  the  dreaded  sum- 
mer season  in  a  city  unharmed  by  the  so  much  dreaded 
summer  weather.  I  mention  this  because,  probably, 
many  mothers  who  read  this  book  cannot  afford  to 
spend  the  summers  out  of  town. 

I  think  a  nursery  should  always  have  an  open  fire- 
place for  ventilation,  and  a  counter-opening  should  be 
made  over  the  window  so  as  to  allow  the  air  to  be 
changed  with  the  least  draught  possible ;  this  can  be 
done  by  pulling  down  the  top  sash,  putting  about  a 
four-inch  strip  of  board  to  keep  it  down,  and  an  in- 
direct current  will  be  made  between  the  sashes.  Of 
all  the  methods  of  heating,  probably  the  most  scientific, 
but  unfortunately  the  one  that  can  be  most  abused,  is 
the  hot-air  furnace.  Parents  should  see  that  their  nur- 
series are  supplied  with  air  that  is,  first  of  all,  pure, — 
it  must  be  taken  at  as  great  a  distance  as  possible  from 
the  ground,  not  immediately  off  of  gutters  and  damp 
yards,  as  is  usually  the  case.  The  air  most  charged 
with  atmospheric  impurities,  whether  they  be  germs  or 
gases,  is  that  which  is  usually  heated  and  sent  to  the 
nursery ;  the  heating  simply  making  it  more  poisonous 
than  before.  The  air  should  be  taken  as  far  from  the 
ground  as  possible,  heated,  and  then  passed  over  a  sur- 
face of  pure  water ;  it  will  receive  a  certain  amount  of 

8* 


90  INFANCY. 

moisture,  and  then  be  carried,  as  free  from  dust  as  pos- 
sible, directly  to  the  nursery.  Air  which  is  not  passed 
over  water  but  simply  dried  will,  undoubtedly,  produce 
various  forms  of  irritation  of  the  mucous  membranes, 
dryness  of  the  throat  and  nose,  languor, — symptoms 
which  we  all  recognize  at  once.  Certainly  nothing 
could  be  better  than  an  open  grate,  with  a  wood-fire, 
even  if  it  be  only  occasionally  used,  to  supplement  the 
furnace,  especially  at  night.  . 

The  sleeping-room  should  be  heated  through  the 
nursery,  if  possible,  and  should  be  only  occupied  at 
night.  Of  course,  I  recognize  that  these  matters  are 
difficult  to  control,  but  at  the  same  time,  if  parents 
know  what  ought  to  be  done  and  take  an  interest  in  the 
matter,  think  for  themselves,  many  arrangements  can 
be  made  to  overcome  temporary  difficulties  which  at 
first  seem  unsurmountable,  and  render  a  dreary,  un- 
healthy nursery,  healthful  and  habitable.  The  nursery 
should  always  have  a  thermometer,  and  the  temperature 
be  kept  about  70°.  The  heat  should  be  always  shut 
off  at  night,  and  the  child's  clothing  so  arranged  as  to 
prevent  its  being  thrown  off  while  the  child  is  perspir- 
ing during  the  early  morning  hours,  when  the  system 
is  most  depressed,  at  which  time  the  danger  of  catching 
cold  is  most  imminent.  Avoid  all  sewerage  arrange- 
ments,— -pipes  of  every  kind, — in  a  nursery.  The  sci- 
ence of  ventilation  and  house-drainage  gives  us  prob- 
ably as  perfect  a  system  as  we  shall  ever  have,  but, 
unfortunately,  the  slightest  fault  of  construction  will 
turn  the  otherwise  harmless  contrivance  for  our  comfort 
into  one  of  the  most  deadly ;  and  there  is  no  means  by 
which  we  can  detect  the  presence  of  the  sewer  air  that 
serves  as  a  carrier  of  the  poison  of  diphtheria  or  typhoid 
fever,  any  more  than  there  is  evidence  of  its  existence 
in  drinking-water,  which  equally  will  serve  to  dissemi- 
nate this  poison.  The  most  costly  habitation  of  the 
wealthy  will  find  these  dreaded  diseases  carried  into  its 


FRESH  AIR,  VENTILATION,  OUT-DOOR  EXERCISE.  91 

midst  to  a  greater  extent  even  than  is  found  among  the 
poor.  The  classes  of  persons  who  suffer  most  from 
diphtheria  are  the  very  wealthy  and  the  very  poor. 
Those  of  moderate  wealth  guard  their  children  care- 
fully against  cold,  in  the  first  place,  and  their  means 
prevent  them  from  having  the  luxuries  which  carry  the 
deadly  sewer  air  into  their  bedrooms.  Physicians  be- 
lieve that  diphtheria  most  frequently  requires  a  cold,  a 
catarrh  in  the  throat,  before  the  poison  is  thoroughly 
absorbed,  and  probably  this  accounts  for  the  resistance 
which  is  observed  in  so  many  cases  against  an  attack 
in  the  summer.  Just  as  soon  as  the  child  takes  cold, 
becomes  a  little  run  down,  that  dreaded  disease,  diph- 
theritic croup,  will  show  itself. 

I  have  laid  great  stress  on  the  importance  of  thor- 
ough ventilation  and  fresh  air,  but  I  wish  to  be  distinctly 
understood  that  constancy  in  the  purity  of  air,  both 
day  and  night,  is  not  only  requisite  in  the  nursery,  but 
also  in  the  sick-room.  Cold  air  is  not  necessarily  pure 
air,  nor  is  air  which  is  warmed  made  impure  by  warm- 
ing ;  at  the  same  time  it  should  be  remembered  that 
frosty  air,  filled  with  germs  of  disease,  may  be  harmless 
to  breathe,  but  the  same  air  warmed  by  a  "  heater"  may 
become  most  deadly.  A  child's  vitality  is  lowered  at 
night,  its  circulation  less,  its  resistance  to  disease  less. 
A  person  sleeping  and  chilled  is  much  more  liable  to 
take  cold  than  one  who  is  awake ;  especially  is  this  so 
in  childhood  and  old  age ;  but  the  temperature  of  the 
sleeping-room  may  become  reduced  at  night,  when  the 
heat  is  turned  off,  with  benefit,  if  the  child  is  covered 
— not  enough  to  induce  perspiration,  and  the  clothing  so 
arranged  as  not  to  be  thrown  off.  Of  course  a  child, 
up  to  at  least  six  months,  should  be  kept  in  a  room 
which  has  as  nearly  as  possible  the  same  temperature 
day  and  night,  as  it  sleeps  most  of  the  time,  and  when 
taken  out  of  doors  is  so  warmly  clad  that  the  change 
of  air  cannot  affect  it. 


92  INFANCY. 

To  sum  up,  then,  a  nursery,  or  child's  living-room 
and  bedroom,  should  be  kept  scrupulously  clean,  thor- 
oughly aired,  freed  from  dust ;  dust,  independent  of  its 
irritating  character  upon  the  mucous  membrane,  is  the 
means  of  conveying  disease.  There  are  many  days  in 
our  treacherous  climate  when  a  child  cannot  be  taken 
out  of  doors ;  indeed,  there  are  many  days  when  a 
child  had  better  remain  in  its  well-aired  nursery,  days 
during  which,  if  it  went  out  of  doors  in  its  peram- 
bulator, it  would  inhale  the  exhalations  from  the  foul 
masses  that  accumulate  in  our  city  streets.  A  child  in 
arms  is  far  safer  when  carried  out  of  doors  for  fresh  air 
than  one  in  its  perambulator,  or  one  who  walks. 

The  day  nursery  should  be  supplied  with  plants. 
They  are  undoubtedly  beneficial  to  health  when  properly 
cared  for,  and  make  the  living-room  bright  and  cheerful, 
and  this  reacts  on  the  disposition  of  the  child.  A  bright, 
happy  home  makes  a  bright,  happy  child,  and  what  is 
taken  for  temper,  perverseness,  in  many  children  is  often 
sickness  and  unhappiness.  Those  who  are  much  thrown 
with  children  recognize  this  fact;  indeed,  it  is  one  which 
every  grown  person  feels  when  he  or  she  looks  back  to 
childhood  days.  The  energy,  buoyancy,  which  comes 
with  good  health,  is  in  marked  contrast  to  the  depres- 
sion and  irritability  that  is  associated  with  illness,  or, 
if  not  exactly  illness,  with  those  sedentary  pursuits  that 
are  in  themselves  unhealthful. 

The  question  is  often  asked  at  what  age  a  child 
should  go  out  of  doors,  and  whether  it  should  go  out 
every  day,  notwithstanding  the  weather.  It  makes  a 
very  great  difference  whether  the  parents  live  in  the 
country,  or  the  city.  Country  children,  of  course,  are 
out  most  of  the  time,  as  they  grow  older  especially ; 
whereas,  in  the  city,  the  impossibility  of  thus  turning 
them  loose  and  the  necessity  of  a  nurse  to  accompany 
them  are  matters,  of  course,  that  have  to  be  taken  into 
consideration.     After  a  babe  is  about  six  weeks  or  two 


FRESH  AIR,  VENTILATION,  OUT-DOOR  EXERCISE.  93 

months  old,  if  the  weather  is  at  all  moderate,  the  nurse 
can  wrap  the  child  well  and  take  it  in  her  arms  out  for 
a  walk.  There  is  less  risk  of  young  children  taking 
cold  than  older  ones,  from  the  fact  that  they  are  much 
easier  wrapped  and  kept  warm,  and  the  nurse  is  able  to 
carry  them.  At  the  same  time,  if  the  house  is  well 
ventilated  and  warm  and  the  weather  cold  and  change- 
able,— dirty  streets,  snow,  and  dampness  rising  from  the 
ground, — it  is  far  better  for  the  child  to  remain  in  the 
house.  As  soon  as  a  child  arrives  at  that  age  when  it 
is  a  drag  upon  the  nurse,  difficult  to  carry,  and  at  the 
same  time  cannot  walk,  and  a  perambulator  is  required, 
the  time  to  exercise  the  most  judgment  has  come.  Any 
mother  can  see  this  for  herself  by  going  to  one  of  our 
city  parks  and  watching  the  congregation  of  nurse-girls 
assembled,  noting  the  position  of  the  baby  carriages 
and  the  condition  of  their  occupants.  A  child  will  be 
left  facing  the  bleakest  March  wind,  or  the  midsummer 
sun  fiercely  attacking  its  unprotected  head,  while  the 
nurse  will  be  engaged  in  conversation  with  a  number 
of  her  friends.  I  have  often  been  at  a  loss  to  know 
how  mothers  could  select  these  young,  inexperienced 
creatures  to  take  care  of  their  children,  knowing  full 
well  what  would  be  the  consequences,  and  then  be 
surprised  if  the  child  should  be  taken  with  a  severe  sore 
throat,  earache,  pneumonia,  or  inflammation  of  the 
brain,  as  a  consequence.  It  would  be  far  better  if  all 
children;  until  they  were  old  enough  to  sit  up  by  them- 
selves, were  carried  by  their  nurses  in  their  every-day 
outing,  and  that  after  a  child  was  too  big  to  carry,  and 
too  young  to  walk,  it  should  sit  up  in  its  carriage  well 
wrapped,  then  the  nurse  take  a  long  walk,  with  the  dis- 
tinct understanding  that  under  no  circumstances  is  the 
carriage  to  be  stopped ;  when  she  is  tired  she  is  to  come 
home.  I  am  very  particular  in  laying  stress  upon  this 
matter,  because,  notwithstanding  all  that  has  been 
written  on   the  subject  and  the  full  knowledge  that 


94  INFANCY. 

mothers  obtain  from  their  family  physicians,  who  are 
one  and  all  opposed  to  the  present  system  and  acknowl- 
edge that  a  larger  part  of  the  diseases  of  children  is  due, 
undoubtedly,  to  the  carelessness,  in  one  way  or  another, 
of  their  nurses, — these  girls,  without  any  experience 
whatever,  with  no  judgment,  certainly  no  affection  for 
their  charges,  hired  and  intrusted  with  the  care  of  an 
infant,  and  allowed  to  take  it  out,  going  where  they  will, 
carry  it  into  heated  rooms,  leave  its  out-door  wraps  on, 
carry  it  out  of  doors  while  it  is  perspiring,  expose  it  to 
contagion  of  every  kind,  taking  it  into  all  sorts  of  atmos- 
pheres ;  and  yet  after  the  child  has  been  returned,  its 
fond  mother  will  fondle  and  caress  it,  guard  it  against 
the  least  exposure,  treat  it  as  the  tenderest  flower,  be 
struck  with  wonder  and  surprise  when  it  is  taken  ill. 
So  important  do  I  deem  it  that  a  child's  nurse  should 
be  selected  with  the  greatest  possible  care,  that  she 
should  be  a  woman  chosen  on  account  of  her  experi- 
ence, conscientiousness,  and  truthfulness,  that  I  believe 
the  mortality  from  contagious  diseases,  and  from  those 
disorders  due  to  direct  exposure,  would  be  diminished 
if  mothers  could  be  made  to  appreciate  this  matter. 


CHAPTER  VII. 

BATHING. 


The  Importance  of  Bathing — A  Child's  Time  for  Bathing  must 
he  regulated  by  the  Child's  Condition,  etc. — The  Cruelty  of 
forcing  Young  Children  to  have  a  Plunge  in  the  Cold  Sea — A 
Child  should  love  its  Bath,  and  how  it  can  be  taught  to  love  it. 

In  speaking  of  the  new-born  babe,  it  was  noted  that 
immediately  after  birth,  instead  of  being  washed,  it 
should  thoroughly  be  greased  with  some  material.    The 


BATHING.  95 

best  substance  to  be  used  for  this  would  probably  be 
washed  lard,  or  the  non-scented  white  vaseline.  The 
child  can  then  be  gently  washed  in  warm  water  with  a 
soft  sponge,  or  soft  linen,  with  Pears'  non-scented,  or 
Castile  soap,  and  care  should  be  taken  that  every  part 
of  the  body  be  carefully  washed,  so  as  to  free  it  from 
any  impurities  that  may  have  secreted  and  caused  irri- 
tation to  the  tender  skin.  It  is  not  necessary  that  at 
first  the  child  should  receive  a  thorough  washing,  but 
certainly  by  the  end  of  twenty-four  hours  its  skin  should 
be  soft  and  pink,  and  every  particle  of  secretion  be  re- 
moved from  it ;  the  nostrils,  the  eyes,  the  mouth,  the 
various  crevices  of  the  groin  and  the  arm-pits  thoroughly 
cleansed. 

There  should  be  a  thermometer  always  in  the  nursery, 
and  the  child's  bath  should  be  always  regulated  by  it. 
The  temperature  of  the  water  should  be  95°,  and  as 
the  child  grows  older  and  becomes  strong,  the  circula- 
tion well  established,  the  temperature  should  be  gradually 
reduced  until  it  is  about  75°  or  cooler.  It  is  not  at  all 
necessary  that  a  child  should  receive  a  full  bath  twice  a 
day ;  once  a  day  is  amply  sufficient,  in  the  morning. 
At  bedtime  a  sponging  off  will  be  enough,  unless  the 
child  is  one  of  those  excitable  dispositions  to  whom  we 
have  already  alluded,  the  child  of  intellectual  parents, 
or  those  who  depend  upon  their  brains  for  a  livelihood : 
these  children  always  exhibit  more  or  less  of  a  nervous, 
irritable  disposition,  which  renders  them  at  times  rest- 
less and  sleepless.  For  such,  the  sedative  effect  of 
a  bath  at  night  is  most  marked ;  indeed,  for  these  it  is 
well  to  usually  sponge  off  with  cool  water  in  the  morn- 
ing, and  leave  the  bath  for  the  night,  making  the  water 
about  95°  in  order  to  get  its  full  sedative  influence. 

It  is  a  very  great  mistake  for  a  child  to  get  accus- 
tomed to  bromide,  valerianate  of  ammonia,  brandy,  or 
gin,  to  make  it  sleep  ;  these  should  never  be  used  with- 
out the  consent  of  the  physician ;  but  the  sedative  influ- 


96  INFANCY. 

ence  of  a  warm  bath,  or  warm  foot-bath,  can  never  be 
harmful.  The  usual  time  for  giving  the  morning  bath 
is  about  nine  or  ten  o'clock  ;  at  this  time  digestion  is  not 
going  on,  as  a  rule,  the  child  can  be  thoroughly  washed, 
the  surface  brought  into  a  glow  either  with  the  hand  or 
a  soft  towel ;  the  child  can  then  take  its  bottle  or  breast, 
get  its  hour's  sleep,  and  there  will  be  still  time  for  it  to 
spend  the  best  part  of  the  day  out  of  doors.  Of  course 
in  summer,  when  the  child  should  be  out  as  much  as 
possible,  the  bath  can  be  given  at  an  earlier  or  later 
hour  to  suit  the  circumstances.  For  a  very  young  infant 
it  is  not  absolutely  necessary  to  give  the  child  a  bath  in 
the  tub  ;  the  room  should  be  warmed  to  a  temperature 
of  about  75°,  guarded  against  draughts. 

The  temperature  of  the  bath,  if  the  child  is  immersed, 
should  be  about  90°,  but  if  the  child  is  delicate  and 
young  a  thorough  sponging  of  the  surface  will  be  suffi- 
cient, and  gradually  it  should  be  accustomed  to  the 
water  until  it  will  of  its  own  accord  show  a  liking  for 
the  bath. 

The  question  often  arises,  How  long  after  feeding 
should  the  child  have  a  bath  ?  Certainly  not  less  than 
an  hour,  better  if  two  hours  should  elapse  after  a  heavy 
meal.  Of  course  this  refers  entirely  to  a  bath  by  im- 
mersion, but  for  a  young  infant  that  is  simply  sponged 
and  nursed  with  breast-milk,  an  hour  will  be  sufficient. 

Often  it  is  necessary  to  bring  about  a  glow  on  the 
surface  of  the  body  for  children  who  are  delicate,  when 
for  some  reason  or  another  the  bath  cannot  be  given ; 
the  body  can  be  gently  rubbed  with  either  spirits  of 
wine  or  washing  whiskey,  to  which  a  little  salt  can  be 
added  to  make  it  more  stimulating ;  or,  if  the  child  is 
very  delicate,  cod-liver  oil  can  be  used  with  rubbing. 

The  child  should  not  be  permitted  to  go  out  imme- 
diately after  its  bath,  nor  indeed  for  an  hour  or  so,  if 
the  weather  be  cold;  but  as  the  day's  sleep  is  given 
immediately  after  the  bath,  scarcely  any  mother  would 


BATHING.  97 

be  tempted  to  take  her  child  out.  Mothers  ought  to 
make  it  a  rule  never  to  take  a  child  out  of  doors  on  an 
empty  stomach ;  not  only  will  a  child  that  has  taken 
food  before  going  out  be  better  able  to  resist  cold,  but 
also  there  will  be  less  chance  of  it  becoming  infected  by 
contagious  diseases. 

"  To  dare  the  vile  contagion  of  the  night 
And  ternpt  the  rheumy  and  unpurged  air, 
To  add  unto  his  sickness." 

If  a  child  objects  very  seriously  to  its  bath,  it  is  far 
better  to  gradually  accustom  it  to  being  immersed,  and 
this  can  be  readily  accomplished  as  a  child  grows  older 
by  teaching  it  to  play  in  its  tub,  and  gradually  fill  it 
with  water;  or  over  the  tub  can  be  thrown  a  light 
blanket,  and  the  child  gradually  immersed,  gently  low- 
ered into  the  water. 

The  question  of  when  a  salt  bath  should  be  used  is 
often  asked.  This,  of  course,  is  a  matter  which,  as  a  rule, 
should  be  left  to  the  family  physician  to  decide.  Salt 
water  is  more  stimulating  than  plain  water ;  it  also  has 
the  advantage  of  being  especially  valuable  in  cases  of 
chronic  enlargements  of  the  glands  and  tonsils,  a  ten- 
dency to  scrofula.  Children  who  lack  muscular  strength, 
have  loss  of  appetite,  sleep  badly,  are  especially  bene- 
fited by  salt-baths.  It  is  not  necessary  to  obtain  what 
is  known  as  sea-salt,  though  this  is  usually  sold  for  that 
purpose. 

As  children  grow  older  the  question  arises  as  to  the 
sea-shore  and  its  advantages,  especially  sea-bathing. 
All  children  who  are  delicate,  those  that  are  scrofulous, 
those  that  are  threatened  with  spinal  curvature,  have  a 
tendency  to  become  bandy-legged  or  pigeon-breasted, 
improve  wonderfully  at  the  sea-shore.  As  far  as  the 
bathing  is  concerned,  surf-bathing  or  cold  sea-water 
should  not  be  used  for  children  under  three  years ;  until 
that  time  the  sea-water  can  be  given  in  the  ordinary 
e       </  9 


98  INFANCY. 

tub,  to  which  has  been  added  a  quantity  of  hot  water 
to  give  it  a  temperature  of  at  least  80°.  Any  one  who 
has  spent  summers  at  the  sea-shore  has  certainly  seen  a 
great  deal  of  the  cruel  practice  of  carrying  a  screaming, 
struggling  infant  in  the  arms  and  plunging  it  into  the 
sea-water.  I  cannot  imagine  a  more  barbarous  pro- 
ceeding. The  sudden  shock  from  the  use  of  cold 
water,  the  fright,  is  enough  to  bring  on  convulsions. 
A  child  at  the  age  of  two  years  can  have  its  bathing 
suit  put  on  in  the  middle  of  the  day,  run  in  its  bare  feet 
in  the  sands,  bask  in  the  sunshine,  get  its  feet  wet  in  the 
cool  sea-water,  and  receive  very  much  more  benefit  than 
it  would  from  a  plunge  into  the  ocean,  even  if  it  could 
be  done  without  the  struggle  which  usually  accompanies 
this  procedure.  Even  for  infants  of  a  year  old,  the 
sponging  of  the  neck  with  cold  water,  dipping  the  feet 
in  the  same,  followed  by  brisk  rubbing,  will  prevent  in 
many  cases  the  taking  of  cold.  I  especially  call  the 
attention  of  mothers  to  this  point ;  it  will  be  a  very 
valuable  procedure,  especially  in  our  changeable  winter- 
climate,  if  adopted  every  night  before  retiring,  to  pre- 
vent the  many  attacks  of  cold  that  are  so  annoying  and 
prevalent. 

Sea-bathing  is  to  be  interdicted  for  rheumatic  chil- 
dren, for  those  with  asthma,  skin-diseases,  and  fevers. 
Kidney-disease,  irritable  lungs,  a  tendency  to  frequent 
bronchitis,  come  under  the  same  category.  In  the  case 
of  heart-disease  the  stimulating  atmosphere  excites  this 
organ  to  too  rapid  action  and  aggravates  the  disorder. 
Weak  eyes  are  to  be  kept  from  the  shore,  where  the  air 
impregnated  with  salt  and  fine  sand  and  glare  keep  up 
a  constant  irritation.  The  same  applies  to  ear  affec- 
tions,  but  with  exceptions,  which,  however,  should  be 
made  only  under  the  advice  of  a  competent  physician. 
Little  consumptives  do  better  in  the  interior,  as  the 
coast  air  is  too  stimulating  for  their  weak  lungs. 

The  action  of  the  skin  is  so  essential  to  good  health, 


BATHING.  99 

that,  except  when  a  child  is  really  ill  and  the  attending 
physician  has  given  his  opinion  that  it  should  not  be 
bathed  or  even  washed,  a  simple  sponging  of  the  surface 
of  its  skin  can  never  do  any  harm ;  of  course  the  water 
can  be  made  tepid,  the  room  carefully  guarded  against 
draughts,  and  the  child  after  being  thoroughly  dried  not 
allowed  to  run  out  in  the  cold  entries  until  the  skin  has 
entirely  reacted.  The  mother  will  often  say,  "  Doctor, 
my  child  has  a  cold ;  shall  I  wash  it  ?"  I  may  answer 
that  when  these  precautions  are  taken,  the  sponging  of 
the  chest  and  throat,  with  subsequent  friction,  is  the 
best  thing;  she  can  do  for  the  cold. 

In  regard  to  the  use  of  cold  water  in  nursery  bathing, 
it  is  a  great  mistake  to  believe  that  a  child  should  be 
sponged  with  cold  water  notwithstanding  its  dread  of  it 
and  the  shock  which  it  gives  to  its  nervous  system.  A 
child  should  be  made  to  love  its  bath,  to  look  forward 
to  it  with  delight ;  it  should  have  a  big  sponge  to  play 
with,  and  in  a  very  short  time,  as  it  grows  older,  it  will 
gladly  sit  in  the  tub  with  the  water,  splash  around  to 
its  heart's  content,  and  get  sufficient  exercise  to  avoid 
any  chances  of  getting  cold. 

In  using  soap,  great  care  should  be  taken  that  it  is 
the  purest  kind,  with  no  free  alkali.  That  which  is  non- 
scented  is  to  be  preferred.  After  the  child  has  been 
dried,  in  summer-time,  its  body  should  be  powdered 
with  a  little  starch  or  talc  powder,  which  has  a  soothing 
effect  upon  the  skin  ;  or  in  winter-time  its  chest  and 
back,  the  folds  of  the  skin  in  the  groin  and  axilla,  can 
be  greased  with  a  little  vaseline,  just  enough  to  make 
the  skin  soft  and  pliable,  and  also  protect  it  from  cold. 

There  is  one  point  of  caution  which  I  think  is  in 
place  here :  a  bath  in  tepid  or  cool  water  for  a  short 
time  is  invigorating;  a  prolonged  soaking  in  warm 
water  has  precisely  the  opposite  effect. 

If  the  child  is  debilitated  during  hot  weather  by  the 
prolonged  heat,  and  a  more  stimulating  bath  than  the 


100  INFANCY. 

ordinary  cool  bath  is  required,  a  teacup  or  two  of  cider 
vinegar  can  be  added  to  the  bath,  with  or  without  the 
addition  of  salt.  In  children  who  have  delicate  skins, 
the  red  spots  or  blotchy  eruption  which  appears  shortly 
after  birth  is  usually  due  to  too  active  use  of  soap  and 
water  immediately  following  their  birth.  This  can  be 
obviated  by  following  the  directions  given  when  speak- 
ing of  the  washing  of  the  new-born  babe  ;  but  very 
frequently  a  child's  skin  becomes  dry,  rough  to  the 
touch,  and  needs  constant  attention  to  prevent  eruptions, 
especially  the  much-dreaded  eczema  of  children.  Such 
children  should  not  have  salt-baths,  except  when  ad- 
vised by  the  physician  ;  they  need  fresh  air,  plain  food, 
and  probably  cod-liver  oil. 


CHAPTER  VIII. 

TEETHING. 

The  Milk-Teeth,  and  when  they  are  usually  Cut — Why  a  Slob- 
bering Babe  suffers  less  from  its  Teeth  than  another — Usual 
Symptoms — "Why  Mothers  dread  a  Child's  Second  Summer — 
Rickets  and  what  is  meant  by  the  Term — Eickets  a  Frequent 
Cause  of  Spinal  Affection— How  a  Pregnant  Woman  may  pre- 
dispose her  Child  to  Eickets — Eat  Children  are  not  always 
healthy  ones — How  to  treat  a  Eickety  Child— A  Teething 
Child  suffers  frequently  from  other  Causes  than  its  Teeth — A 
Child  should  have  Sufficient  Sleep — Why  so  many  Little  Ones 
are  wakeful — How  Sleeplessness  can  be  remedied — The  Diet 
of  a  Teething  Child. 

The  first  lower  incisors — that  is,  the  two  lower  front 
teeth — are  usually  cut  when  the  child  is  from  six  to 
seven  months  old.  For  some  time  previous  it  has  prob- 
ably been  noticed  that  the  child  has  been  restless  and 
uneasy,  that  its  sleep  has  either  been  disturbed  or  it 
has  been  wakeful.     Before  this  time  the  child's  secre- 


TEETHING.  101 

tions  have  been  pretty  well  established.  The  tears,  the 
saliva,  will  probably  flow  readily ;  indeed,  such  children 
usually  cut  their  teeth  wTith  little  trouble.  It  is  doubt- 
ful whether  all  the  troubles  that  are  associated  with 
teething  are  really  due  to  that  condition.  There  is  no 
question  but  that  the  pressure  upon  the  delicate  nerve- 
pulp  beneath  a  tooth,  that  is  bound  down  by  a  thick 
capsule,  and  probably  on  top  of  that  a  congested  gum, 
may  give  rise  to  serious  trouble,  amounting  to  convul- 
sions or  intestinal  disturbance  at  times ;  or  the  irrita- 
tion which  is  produced  may  inflame  the  gum,  and  thus 
starting  as  a  sore  mouth,  the  dryness  of  the  mucous 
membrane  extends  to  the  stomach,  and  is  the  starting- 
point  of  a  severe  catarrh. 

As  a  rule,  children  suffer  comparatively  little  with 
their  early  teeth  ;  possibly  because,  while  these  are  being 
cut,  they  are  still  nursing  in  many  cases,  or  they  have 
not  yet  had  a  large  amount  of  farinaceous  food  added  to 
their  diet.  Then,  also,  the  large  back  teeth  and  the  eye- 
teeth  cause  far  more  pressure  on  the  delicate  nerve-pulp, 
more  disturbance  in  the  jaw,  and  therefore  are  followed 
by  a  greater  degree  of  sympathetic  derangement.  This 
sympathetic  derangement  may  show  itself  in  excitement 
of  the  nervous  system,  especially  at  night,  and  be  one 
of  the  most  active  causes  of  sleeplessness ;  also  in  its 
action  upon  the  glands  that  secrete  the  fluids  used  in 
digestion,  and  it  is  on  this  account  the  second  summer 
is  to  most  mothers  a  dreaded  time,  as  then  a  baby  is 
usually  weaned,  and  the  slightest  neglect  in  the  prepa- 
ration of  its  bottle  will  permit  of  the  fermentation  of 
the  starchy  material  that  faulty  secretion  prevents  from 
turning  into  grape  sugar. 

Nature's  plan  is  to  keep  the  gum  softened,  by  being 
soaked  in  saliva  ;  it  also  uses  the  bowels  as  a  sort  of 
safety-valve  to  relieve  the  congested  nervous  system. 
A  large  watery  movement  of  the  bowels  wall  cause  a 
shrinkage  in  the  gums,  by  depriving  them  of  water,  and 

9* 


102  INFANCY. 

often  take  the  place  of  the  lancet.  Congestion  may  be 
present  in  the  delicate  nerve-pnlp  beneath  the  teeth,  and 
give  rise  to  annoyance,  irritation,  pain,  and  at  the  same 
time  the  gum  above  give  no  evidence  whatever,  by  its  ap- 
pearance, of  what  is  going  on  beneath.  A  child  suffer- 
ing in  this  way  from  its  teeth  will  crave  something  to 
bite  upon,  but  as  soon  as  it  takes  the  nipple  of  its  bottle 
in  its  mouth,  its  finger,  or  even  its  thumb,  and  bites 
upon  it,  it  will  suddenly  throw  it  from  it,  and  show 
evidences  of  pain.  The  relief  that  comes  from  the  soak- 
ing of  the  gums  is  very  great ;  it  is  said  that  children 
who  suck  their  thumbs  seldom  have  trouble. 

By  the  time  a  child  reaches  two  and  a  half  years,  it 
should  have  cut  its  entire  twenty  teeth.  They  are  usu- 
ally cut  in  pairs  :  first  the  lower  two  incisors,  then  the 
upper  two,  then  the  outside  two  above,  then  below, 
next  to  those  first  cut,  then  skipping  a  space  for  the  eye- 
and  stomach-teeth,  the  others  will  come  in  turn.  From 
the  sixteenth  to  the  twentieth  month  the  eye-  and 
stomach-teeth  will  be  cut. 

The  cutting  of  the  teeth  by  no  means  always  follows 
in  this  order,  nor  indeed  do  we  always  find  the  first 
appearance  of  the  lower  incisors  as  early  as  the  sixth  or 
seventh  month.  Sir  William  Jenner  has  stated  that  if 
a  child  does  not  cut  its  first  tooth  within  a  year,  it  is  an 
undoubted  sign  of  rickets. 

I  think  it  well  here  to  make  a  few  remarks  on  the 
subject  of  rickets,  that  the  mother  may  fully  understand 
what  is  meant  by  the  term.  To  some  people  no  greater 
insult  can  be  offered  than  to  suggest  that  their  children 
are  rickety ;  to  their  mind,  the  word  seems  to  imply 
some  constitutional  taint  to  be  ashamed  of.  This  is  a 
great  mistake.  So  large  a  proportion  of  children  have 
rickets  to  a  more  or  less  marked  extent  that  physicians 
feel  the  necessity  of  impressing  upon  the  community 
the  great  importance  of  attention  to  the  very  subjects 
to  which  this  book  is  devoted.     Rickets  is  a  condition 


TEETHING.  103 

the  result  of  faulty  nutrition ;  it  is  found  among  the 
rich  as  well  as  the  poor.  It  is  the  result,  in  the  latter, 
of  exposure,  starvation,  neglect;  in  the  former,  the 
direct  consequence  of  high  pressure,  nervous  exhaus- 
tion, improper  feeding, — in  other  words,  wilful  negli- 
gence or  ignorance.  The  mother  who  fails  to  nurse  her 
babe,  and  turns  it  over  to  the  tender  mercies  of  an 
ignorant  nurse  and  a  bottle,  should  not  be  surprised  if 
her  child  suffers  in  consequence.  No  more,  indeed, 
should  one  ignorant  of  the  fact  that  starchy  food 
will  ferment  and  be  productive  of  harm,  be  surprised 
to  see  her  child  develop  spine-disease  or  become  bow- 
legged. 

By  rickets  we  mean  a  disease  of  the  nutrition  of ' 
the  body  whereby  its  natural  growth  and  development 
are  arrested,  the  formation  of  bone  is  retarded,  and  the 
pressure  exerted  by  the  muscles  and  the  weight  of  the 
body  causes  deformities  which  later  in  the  disease  be- 
come permanent.  This  want  of  bone-deposit  delays  the 
formation  of  teeth ;  the  interference  with  nutrition  causes 
wasting  of  the  muscles,  produces  disorders  of  digestion, 
and  also  shows  itself  in  affections  of  the  lymphatic 
glands,  the  liver,  the  spleen,  and  the  brain.  Its  causes 
are  bad  feeding,  want  of  sunshine,  dampness,  want  of 
cleanliness ;  and  yet  so  gradual  and  slow  is  the  process 
by  which  this  faulty  nutrition  shows  itself,  that  many 
children  who  are  seemingly  strong  and  hearty  will  mani- 
fest signs  of  rickets  towards  the  end  of  their  early  den- 
tition. 

Rickets  is  in  nearly  all  cases  developed  after  birth, 
usually  about  the  fifth  or  sixth  month. 

As  regards  the  normal  growth  of  the  child  during 
the  first  year  of  its  life,  the  average  growth  is  about 
eight  inches  ;  during  the  second  year  about  four  inches, 
and  at  this  time  it  is  supposed  to  have  attained  half  of 
its  full  adult  height.  As  regards  weight,  at  the  end  of 
the  first  year  it  has  gained  about  three  times  its  weight 


104  INFANCY. 

at  birth,  but  during  the  second  year  it  has  only  increased 
this  by  about  one-third. 

I  have  endeavored  to  impress  upon  mothers  the  great 
importance  during  pregnancy  of  leading  the  sort  of  life 
that  will  give  them  good  digestion, — plenty  of  fresh  air 
and  exercise, — and  of  a  diet  that  will  supply  all  the 
demands  of  nature.  Otherwise  at  this  time  they  are 
the  ones  who  will  suffer ;  nature  will  draw  from  them 
the  material  to  supply  bone  to  their  infant.  The 
nursing  mother  should  also  be  most  careful  in  her  modp 
of  life,  knowing  that  the  nutrition  of  two  individuals 
depends  upon  herself.  Should  the  supply  fail,  one  or 
the  other  will  suffer.  Infants  deprived  of  the  materials 
that  go  to  the  formation  of  bone,  lime-salts,  will  de- 
velop rickets  though  they  may  be  fat ;  because  excessive 
storage  of  fat  is  no  evidence  of  health,  but,  on  the  con- 
trary, is  often  evidence  of  faulty  nutrition.  The  failure 
of  the  diamond-shaped  opening  on  the  top  of  a  child's 
head  to  close  before  the  end  of  the  first  year,  the  delay 
in  cutting  its  first  tooth  until  the  expiration  of  this 
period,  the  tendency  to  enlargements  of  the  glands,  espe- 
cially the  tonsils,  disturbances  of  the  bowels,  especially 
that  form  where  bile  does  not  seem  to  be  properly  se- 
creted, the  tendency  to  perspire  at  night  about  the 
head  or  neck,  notwithstanding  the  fact  that  the  child 
seems  fat  and  well  nourished,  are  all,  particularly  when 
found  associated  in  the  same  case,  evidences  of  rickets, 
and  a  child  presenting  these  symptoms  should  at  once 
have  a  change  of  air  and  diet,  and  be  placed  under 
medical  treatment. 

These  symptoms  may  occur  in  a  child  that  is  nursed 
by  a  seemingly  healthy  mother ;  in  fact,  we  often  find 
that  the  healthiest-looking  woman  is  the  one  whose 
milk  is  least  nutritious.  They  are  apt  to  occur  in  a 
child  that  has  followed  rapid  successive  pregnancies ; 
almost  certain  to  take  place  should  the  mother  while 
pregnant  attempt  to  nurse  a  child,  and  will  very  fre- 


TEETHING.  105 

quently  be  noticed  exclusively  in  children  who  have 
been  nursed  too  long.  Too  early  weaning,  especially 
if  the  bottle  be  made  up  of  starchy  food  improperly 
cooked  or  given  in  too  large  quantities,  will  be  a  cause 
of  rickets.  Such  children  will  develop,  besides  the 
other  evidences  above  noted,  large  bellies  distended  with 
wind,  vomiting  occasionally  sour  matter,  alternating 
diarrhoea  and  constipation,  and  the  stools  will  most 
frequently  be  found  either  chalky  or  putty-like,  and 
containing  quantities  of  mucus.  If  a  child  is  late  in 
cutting  its  first  teeth,  though  rickets  may  not  be  pres- 
ent, there  is  something  faulty  in  its  condition.  By  late, 
I  mean  if  it  has  not  cut  its  front  tooth  by  the  tenth 
month.  Such  a  child  should  be  carefully  watched,  its 
diet  freely  supplied  with  bone-forming  material ;  it 
should  be  given  Mellin's  or  Horlick's  food  with  its 
bottle,  or  (Trommer's)  extract  of  malt,  without  hops  (a 
teaspoonful  to  the  bottle).  It  should  have  a  salt-bath 
daily,  its  muscles  should  be  exercised  by  daily  rubbing 
or  massage,  and  under  no  circumstances  should  such  a 
child  be  allowed  to  stand  on  its  feet  until  it  has  demon- 
strated its  ability  to  do  so  after  the  gradual  strengthen- 
ing of  its  bones  and  muscles  by  creeping. 

A  great  mistake  is  often  made  by  permitting  a  child 
to  creep  in  one  position.  These  children  also  should 
be  watched  with  care,  that  they  receive  no  sudden 
shock,  or  blow,  or  fall.  Spinal  curvature  may  be 
the  result ;  distortion  of  their  hip-bone  or  pelvis, — a 
serious  matter  if  they  are  girls, — or  hip-disease  may 
develop  most  insidiously.  Diseases  of  the  lungs 
should  be  guarded  against,  as  bronchitis,  pneumonia, 
etc.,  as  the  difficulty  in  breathing  will  press  the  weak 
ribs  out  of  position  and  keep  them  so,  making  them 
pigeon-breasted.  It  is  said  that  those  children  who 
cannot  digest  starchy  food  are  more  apt  to  suffer  from 
rheumatism. 

I  have  dwelt  at  length  upon  this  matter  in  order  to 


106  INFANCY. 

show  that  what  is  usually  attributed  to  difficult  dentition 
— the  head-sweating,  digestive  disturbances,  sleepless- 
ness— in  many  cases  may  have  nothing  whatever  to  do 
with  dentition,  the  difficult  dentition  being  simply  a 
symptom  in  the  course  of  the  disease.  Malnutrition, 
rickets,  is  the  true  cause.  There  are  certain  disturbances, 
mechanical  ones,  that  are  caused  by  the  pressure  of  the 
teeth  upon  the  nerve-pulps  beneath,  that  are  especially 
noticeable  in  children  of  highly  nervous  organization, 
those  whose  parents  are  brain -workers,  and  in  these 
cases  we  are  apt  to  have  disorders  of  digestion,  malnu- 
trition, brain-excitement,  resulting  in  sleeplessness  and 
possibly  convulsions.  Especially  do  these  conditions 
manifest  themselves  during  the  cutting  of  the  back 
teeth,  as  the  molars,  the  eye-teeth,  and  stomach-teeth ; 
the  eye-teeth,  so  called  because  their  cutting  is  usually 
accompanied  by  more  or  less  disturbance  in  the  circula- 
tion of  the  brain  and  the  upper  parts  of  the  face,  giving 
rise  to  excitement,  to  sleeplessness,  or  to  catarrh  in  the 
nose  or  in  the  eyes,  and  the  stomach-teeth  because  their 
cutting  is  usually  accompanied  by  disorders  of  diges- 
tion. 

Sleeplessness  and  irritability  seem  a  constant  accom- 
paniment of  the  teething  process.  A  new-born  infant 
sleeps  from  fifteen  to  eighteen  hours  out  of  the  twenty- 
four  ;  a  child  of  two  years  should  sleep  with  little  inter- 
ruption at  least  ten  or  eleven  hours  at  night,  and  from 
one  to  two  hours  in  the  middle  of  the  day,  but  sleep- 
lessness is  not  always  an  evidence  that  the  child  is  suf- 
fering. Habit  has  much  to  do  with  this  condition.  A 
child  should  be  prepared  for  sleep ;  its  hours  should  be 
as  regular  as  clockwork,  and  under  no  circumstances 
should  it  be  allowed  to  pass  its  sleep-time.  Especially 
is  this  rule  important  during  the  time  of  teething.  The 
reasons  that  many  children  are  sleepless  are,  first  of  all, 
our  city  children  are  of  an  excitable  temperament ;  they 
do  not  get  sufficient  fresh  air  or  exercise,  and  in  conse- 


TEETHING.  107 

quence  the  fatigue  which  should  naturally  invite  pro- 
found and  peaceful  sleep  is  accompanied  by  a  degree  of 
excitement  that  prevents  this. 

Sleeplessness  from  this  cause  can  be  remedied  by  at- 
tention to  these  matters.  It  is  produced  by  exciting  a 
child  just  before  its  sleep-time,  especially  after  it  has 
taken  its  bottle;  its  bottle  or  bowl  of  food  should 
be  given  the  very  last  thing.  The  drowsiness  which 
follows  this  meal,  if  once  disturbed,  will  cause  a  wake- 
ful night.  Among  the  poor,  the  father  comes  home 
tired  from  overwork,  and  the  family  retire  together  at 
an  early  hour ;  with  the  well-to-do,  the  lights  are  all 
lighted,  the  older  children  have  their  romp,  or  the 
baby,  if  it  be  the  first,  has  to  have  its  half-hour  of  play 
with  the  father,  and  possibly  the  excitement  of  its  brain 
may  cause  a  restless  first  sleep  and  wakefulness  for 
the  greater  part  of  the  night.  For  such  cases  a  hot 
foot-bath  will  have  a  most  soothing  effect,  or,  if  they 
still  resist,  the  morning  bath  can  be  postponed  until 
evening,  giving  a  hot  bath  at  this  time,  and  a  sponging 
in  the  morning  instead.  In  these  cases,  a  bottle  of  food 
as  warm  as  the  child  can  take  it,  consisting  of  Mel- 
lin's  food  and  water,  the  proportions  being  a  table- 
spoonful  of  the  food  and  water  to  fill  the  bottle,  which 
will  put  the  child  to  sleep.  If  the  wakefulness  is  due 
simply  to  excitement,  the  child  seeming  perfectly  well 
otherwise  during  the  daytime,  medicine  should  be 
avoided,  unless  specially  ordered  by  a  physician.  The 
habit  of  giving  bromide,  for  no  other  reason  than  simply 
wakefulness,  is  a  mistake. 

Another  cause  of  sleeplessness  is  insufficient  nourish- 
ment ;  we  sometimes  see  such  cases,  where  the  mother 
is  gradually  losing  her  milk  :  its  bulk  remains  prob- 
ably the  same,  but  it  is  losing  its  richness  or  quality. 
Children  fed  on  condensed  milk  alone  are  sometimes 
underfed,  from  the  fact  that  the  milk  is  given  too  highly 
diluted.     One  part  to  twelve  of  water  should  be  the 


108  INFANCY. 

strength  up  to  the  second  or  third  month ;  after  that, 
about  one  part  to  ten  or  eight,  as  the  child  grows  older, 
or,  better  still,  increasing  the  quantity  of  cream.  But 
I  fear  that  among  those  who  will  be  readers  of  this 
book  the  greater  cause  will  come  from  overfeeding.  A 
restless  infant,  and  especially  a  child  about  a  year  old, 
who  tosses  in  its  sleep,  cries  out,  mutters,  dreams,  is 
one  in  all  probability  who  is  receiving  food  in  excess, 
or  is  certainly  not  getting  rid  of  the  surplus  in  a 
proper  way ;  if  the  mother  notices  that  a  sleepless,  rest- 
less child,  at  whatever  age  it  be,  has  a  furred  tongue, 
that  its  breath  is  heavy,  that  its  urine  is  scanty,  high 
colored,  or  that  it  passes  water  very  frequently,  prob- 
ably wets  its  bed  at  night,  she  will  know  that  the  child 
needs  a  laxative,  to  be  followed  by  a  change  in  its  diet, 
— a  dose  of  Husband's  magnesia,  about  a  quarter  of  a 
teaspoonful,  or,  probably  better  than  all,  a  dose  of 
castor  oil,  followed  next  day  by  a  limited  amount  of 
milk,  substituting  chicken-broth  and  avoiding  oatmeal 
or  beef-juice  until  the  bowels  become  more  free.  This 
form  of  sleeplessness  is  most  apt  to  be  noted  at  about 
the  end  of  the  first  year.  With  some  children  the  con- 
stant diet  of  oatmeal  without  any  variation,  the  daily 
use  of  the  expressed  juice  of  beef,  and  at  the  same  time 
large  quantities  of  milk,  which  at  this  period  is  not 
often  much  diluted,  will  bring  about  the  form  of  diges- 
tive disturbance  just  mentioned,  and  a  degree  of  ner- 
vous excitability  that  is  often  referred  to  the  teething 
process  alone. 

We  often  hear  of  children  who  are  said  to  be  suffer- 
ing when  cutting  their  back  teeth,  and  upon  investiga- 
tion find  that  they  are  taking  about  a  quart  of  milk  a 
day,  with  a  tablespoonful  of  Mellin's  food  in  each  bot- 
tle, an  ounce  or  two  of  the  expressed  beef,  possibly  a 
bowl  of  oatmeal  food,  and  in  addition  are  constipated, 
get  no  fresh  air, — in  fact,  are  city  children,  surrounded 
by  all  the  disadvantages  that  our  changeable  and  treach- 


TEETHING.  109 

erous  climate  affords ;  viz.,  overheated  houses  and  im- 
pure air.  A  child  of  this  sort,  if  given  chicken-broth 
instead  of  beef-juice,  less  Mellin's  food,  thin  bread  and 
milk  instead  of  oatmeal,  allowed  to  drink  freely  of 
water,  and  given  an  occasional  laxative,  will  soon  cease 
to  suffer  with  its  teeth. 

Sleeplessness  may  arise  from  pain  ;  especially  is  this 
the  case  in  bottle-fed  children,  who  suffer  from  neural- 
gia, muscular  soreness,  possibly  vague  rheumatic  pains, 
supposed  by  many  to  be  caused  by  the  fermentation  of 
the  sugar  or  starches  which  they  are  unable  to  digest. 
A  child  that  is  fed  upon  too  much  sugar  will  develop 
acidity ;  the  same  with  starch ;  this  leads  possibly  to 
rheumatism,  or  rheumatic  neuralgia,  called  growing 
pain,  and  eventually  to  rickets,  restlessness,  sleepless- 
ness, or  sudden  starting,  soreness  to  the  touch,  no  desire 
for  exercise,  peevishness,  or  possibly  extreme  pain  upon 
movement.  When  the  child  is  lifted  suddenly,  or  is 
handled  while  dressing,  it  will  cry, — all  important 
symptoms  of  this  condition. 

An  extra-sensitive  nervous  system  will  probably 
cause  neuralgia  through  the  jaw  and  head,  earache, 
in  some  children,  from  tooth-pressure ;  this  cause  is 
recognized  from  the  fact  that  these  children  will  avoid 
anything  placed  in  the  mouth,  even  the  nipple  of  their 
nursing-bottle.  The  gums  may  be  slightly  swollen, 
but  not  inflamed  or  in  themselves  tender,  but  the  least 
pressure  upon  them  with  the  finger  will  cause  intense 
suffering.  In  a  case  of  this  kind,  if  severe, — the  child 
restless,  starts  in  its  sleep,  refuses  food, — the  gum  should 
be  lanced.  A  cross-cut  that  will  open  the  capsule  of 
the  tooth  will  in  a  moment  relieve  the  pressure.  If 
this  is  impossible,  a  hot  bath  or  hot  foot-bath  should  be 
given,  also  an  enema  of  warm  water,  and  if  the  child  still 
suffer,  and  the  mother  is  away  from  the  doctor,  she  may 
give  two  grains  of  bromide  of  potassium,  or  five  drops 
of  the  elixir  of  the  valerianate  of  ammonia,  the  latter 

10 


HO  INFANCY. 

to  be  repeated  in  the  course  of  an  hour  if  necessary. 
These  are  the  cases  in  which  the  bromide  of  potas- 
sium, if  given  judiciously,  is  of  the  greatest  value; 
they  present  the  purely  nervous  type,  and  the  nervous 
system  should  be  soothed  by  precisely  the  same  mode 
of  treatment  that  one  would  adopt  for  a  severe  neu- 
ralgic headache.  The  bromide  may  be  given  with  a 
teaspoonful  of  syrup  of  lactucarium,  or  a  teaspoonful 
of  orange-flower  water.  If  the  excitement  is  great, 
the  child  of  a  year  old  should  take  about  four  grains  of 
bromide ;  should  a  convulsion  threaten  or  occur,  the 
proper  treatment  is  warmth  and  counter-irritation  to 
the  whole  body,  a  hot  mustard-bath  as  hot  as  can  be 
borne  by  the  mother's  arm,  or  hot  mustard-poultices  to 
the  legs,  abdomen,  and  back,  which  some  prefer;  an 
enema  of  two  ounces  of  water,  about  the  temperature 
of  100°,  containing  one  teaspoonful  of  the  tincture  of 
assafcetida.  After  the  bath  the  child  should  be  thor- 
oughly wrapped  in  a  blanket,  and  the  only  food  given 
it  for  a  time  should  consist  of  the  blandest  kind,  such 
as  barley-water,  wine-whey,  or  chicken-tea.  Mothers 
should  not  give  their  children  ipecac  in  this  condition, 
unless  there  is  decided  evidence  of  indigestion,  it  being 
very  irritating,  and  the  strain  produced  by  vomiting 
may  be  productive  of  harm.  Ten  drops  of  the  aro- 
matic spirits  of  ammonia,  or  ten  drops  of  brandy,  whis- 
key, or  gin,  in  two  tablespoonfuls  of  warm  water,  are 
far  better,  when  given  to  the  child  as  soon  as  it  can 
swallow ;  if  there  is  any  offending  matter  in  the  stom- 
ach, it  will  act  sometimes  as  an  emetic. 

There  is  another  cause  of  restlessness  and  sleepless- 
ness from  teething,  that  due  to  the  congestion  of  gum 
and  inflammation  of  the  mucous  membrane  of  the 
mouth.  We  more  frequently  find  this  condition  when 
the  back  teeth  are  being  cut,  and  in  children  who  se- 
crete but  little  saliva.  The  gum  is  found  swollen,  red ; 
the  mouth  is  dry ;  the  child  will  turn  away  from  more 


TEETHING.  HI 

solid  food,  and  will  eagerly  drink  water  to  allay  the 
irritation  in  its  mouth.  Frequently,  if  it  is  during  the 
second  summer,  it  will  be  accompanied  by  diarrhoea, 
from  the  fact  that  the  mucous  membrane  extends  to 
the  stomach  and  bowel.  Very  often  small  ulcers  form 
in  the  fold  of  the  cheek  or  the  surface  of  the  gum,  be- 
come coated  with  secretion,  and  are  exceedingly  pain- 
ful. If  there  is  disturbance  in  digestion,  little  round 
vesicles,  which  burst  and  form  ulcers  with  a  grayish 
coating,  will  form  on  the  inside  of  the  cheek  or  the  lips, 
and  on,  or  beneath,  the  tongue.  These  aphthae  will 
annoy  the  child  extremely,  and  produce  sleeplessness ; 
they  are  the  result  of  indigestion,  not  of  teething, 
though  frequently  associated  with  it.  The  physician 
will  probably  give  a  little  calomel  and  soda  to  correct 
the  digestive  disturbance,  or  the  mother  can  give  some 
magnesia,  or  from  ten  to  twenty  drops  of  spiced  rhu- 
barb with  a  teaspoonful  or  two  of  soda  mint,  given  once 
a  day  until  the  bowels  become  regulated ;  at  the  same 
time  the  child  can  have  its  mouth  washed  gently  with 
a  soft  piece  of  linen,  with  a  solution  composed  of  a 
pinch  of  borax,  a  teaspoonful  of  glycerin,  and  a  table- 
spoonful  of  rose-water. 

The  congestion  of  the  gum  of  which  we  have  been 
speaking  causes  the  child  to  crave  salty  food ;  indeed, 
this  is  an  effort  of  nature  to  relieve  this  condition  by 
inducing  a  flow  of  saliva.  Lancing  the  gums  will  often 
be  of  great  service,  by  the  relief  it  gives  to  congestion ; 
instead  of  this  the  child  should  be  given  something 
to  bite  upon,  and  it  will  probably  obtain  relief  in  that 
way.  The  small  bone  of  a  well-boiled  ham  is  salty, 
and  the  child  will  eagerly  suck  it,  and  frequently  bite 
it.  A  chicken-bone,  slightly  salted,  is  most  useful,  or 
it  can  be  allowed  to  bite  on  a  piece  of  rare  roast- beef, 
and  possibly  the  eagerness  with  which  it  will  seize  upon 
it  may  cut  the  gum  from  below  the  sharp  points  of  its 
tooth.     Children  who  suffer  thus  from  their  gums  often 


112  INFANCY. 

get  relief  from  Mellin's  food,  tied  in  a  rag  and  given  the 
same  as  the  ham  or  chicken-bone. 

To  sum  up,  the  object  to  be  secured  is  the  free  flow 
of  saliva ;  it  will  relieve  congestion  and  soften  the  gum. 
It  is  a  mistake  to  rub  a  gum  under  such  circumstances 
by  hard  dry  friction,  but  if  the  little  one  suffers  so  as  to 
disturb  its  sleep,  the  mother's  finger  dipped  in  the  syrup 
of  lactucarium,  or  even  in  paregoric  and  glycerin,  can 
be  gently  carried  over  the  tender  and  inflamed  gum, 
and,  by  gentle  pressure,  soothe  instead  of  irritate ;  and 
now  and  then  a  little  firmer  pressure  may  allow  the 
point  of  a  tooth  to  force  its  way  through. 

In  these  cases,  a  hot  foot-bath  again  has  its  advan- 
tages, by  relieving  the  congestion  of  the  head  and  mouth  ; 
or,  if  the  child  is  constipated,  the  operation  of  a  laxative 
will  be  followed  by  relief  to  its  congested  gum.  The 
latter  will  shrink,  and  a  point  of  the  tooth  will  emerge 
from  its  captivity. 


CHAPTER    IX. 

DIET  AETEK  EAELT  DENTITION. 

The  Necessity  of  a  Careful  Selection  of  Diet — -The  Advantages  and 
the  Disadvantages  of  taking  a  Child  to  the  Tahle — The  Necessity 
of  discriminating  between  Children  as  to  their  Diet — Why  what 
is  Meat  to  one  Child  is  Poison  to  Another — Exercise  is  Essen- 
tial. 

After  a  child  has  cut  its  twelve  teeth,  it  is  well  to 
give  it  more  solid  food  than  what  it  has  been  accustomed 
to  take.  Probably  the  milk  diet  has  been  continued, 
or  the  bread  and  milk,  up  to  this  period,  in  addition  to  the 
mutton,  chicken-broth,  or  beef-soup,  and  our  endeavor 
now  should  be  to  encourage  digestion  of  more  solid  food 


DIET  AFTER  EARLY  DENTITION.  H3 

by  adding  it  more  gradually  to  the  diet  to  which  the 
child  has  been  accustomed.  In  almost  every  house  is 
kept  on  hand  what  is  known  as  stock  ;  this  forms  a  very 
valuable  addition  to  a  child's  dietary,  as  it  is  nutritious, 
palatable,  and  can  be  flavored  so  as  to  make  a  chauge. 
A  child  about  two  years  old  can  have  a  more  solid  mid- 
day meal,  composed  of  a  rare  piece  of  tenderloin  or 
piece  of  juicy  mutton-chop,  with  some  well-boiled  rice 
or  a  thoroughly  roasted  dry  mealy  potato,  in  addition  to 
its  soup.  For  its  breakfast,  instead  of  the  bottle,  a  child 
of  this  age  could  take  a  small  plate  of  about  a  tablespoon- 
ful  of  cracked  wheat  mush,  which  must  be  thoroughly 
boiled  or  steamed,  or  oatmeal,  or  yellow  corn-meal,  or 
white  grits  of  moderate  consistency,  but  thoroughly 
boiled,  and  milk.  If  a  little  salt  is  added  to  these  while 
boiling,  flavored  in  this  way,  it  is  preferable  to  giving 
sugar.  I  think,  indeed,  this  is  a  better  plan  than  mixing 
with  sugar  or  the  other  alternative  of  using  salt  and 
butter ;  butter  in  that  way  will  certainly  upset  a  child's 
digestion. 

A  soft-boiled  egg,  with  bread  and  butter  and  a 
tumbler  of  milk,  is  about  the  best  breakfast  a  child  can 
have  at  this  age.  If  it  sits  at  the  table  and  is  taught  to 
eat  slowly,  it  will  not  become  dyspeptic.  Between  times, 
if  a  child  is  thirsty,  a  drink  of  milk  is  admirable.  With 
its  dinner,  water  is  probably  better ;  I  certainly  have 
found  it  so  in  children  who  are  of  a  bilious  habit.  It 
is  a  great  mistake  to  give  a  child  sweet  things  before  its 
meal ;  after  dinner  it  might  be  allowed  to  have  some 
mild  dessert,  custard  or  pudding  that  is  light,  sponge- 
cake, or  a  baked  apple,  or,  indeed  (after  it  has  cut  its 
twelve  teeth),  a  piece  of  ripe,  raw  apple  or  peach  will 
have  a  good  effect  on  its  bowels.  The  great  advantage 
of  bringing  a  child  to  the  table  to  eat  with  its  parents  is 
that  it  is  taught  to  eat  properly,  to  masticate  its  food 
thoroughly,  which  is  the  great  secret  for  avoiding  dys- 
pepsia; and  also  the  child  can  be  so  trained,  if  its 
h  10* 


114  INFANCY. 

parents  wish,  to  see  things  that  it  knows  it  should  not 
have  by  asking  for  them.  It  is  a  great  mistake  to  spoil 
a  child  so  that  it  will  refuse  when  at  the  table  the  proper 
sort  of  food,  and  cry  constantly  for  the  impossibility.  A 
taste  of  this  or  that  at  the  table  may  not  result  at  the 
time  being  in  bringing  on  troubles  with  digestion, 
but  the  parents  are  sure  to  suffer  for  it  in  the  future. 
We  so  often  make  the  mistake  of  believing  that  children 
are  rendered  strong  and  hardy  by  inattention  to  these 
matters  of  diet  and  clothing,  that  carelessness  makes 
the  child  hardy,  that  the  child  that  is  strictly  brought 
up  is  usually  a  sickly  one.  I  acknowledge  that  at  times 
great  mistakes  have  been  made  by  over-carefulness, 
that  the  scientifically  brought  up  child  is  not  always 
the  most  healthy.  "We  can  overdo  these,  as  we  can 
everything  else.  It  is  always  well  to  make  your  list 
for  the  child's  bill  of  fare  as  large  as  possible,  and  give 
it  its  choice ;  but  always  adhere  to  the  lines  of  digesti- 
bility, and  avoid  those  articles  that  every  one  knows 
are  absolutely  indigestible  or  at  least  harmful  and  irri- 
tating, such  as  veal,  pastry,  unripe  fruit,  sweets,  and 
do  not  believe  that  because  children  sometimes  escape 
the  dangers  that  indulgent  parents  bring  upon  them, 
the  words  of  advice  only  come  from  those  who  are  too 
highly  scientific  in  their  ideas  ! 

The  highly-educated  classes  and  those  who  live  by  their 
brains  alone  are  notoriously  dyspeptic,  and  the  children 
of  these  undoubtedly  inherit  the  weak  digestions  of  their 
parents  as  they  do  their  more  highly-organized  brains 
and  possibly  larger  heads.  They  are  more  subject  to  acute 
brain-troubles  from  this  cause,  and  they  are  certainly 
more  subject  to  all  the  influences  which  produce  intestinal 
disorders,  and  cannot  possibly  digest  the  same  food  that 
will  agree  with  a  child  of  the  same  age,  of  the  less  intel- 
lectual and  the  laboring  classes.  I  think  this  is  a  matter 
which  every  mother  should  thoroughly  understand ;  it 
explains  to  her  why  the  one  child  will  thrive  on  food 


DIET  AFTER  EARLY  DENTITION.  H5 

that  would  be  poison  to  another ;  it  will  prove  to  her 
beforehand,  without  the  necessity  of  an  experiment,  that 
her  child  would  not  be  made  more  hearty  by  feeding  on 
the  boiled  potatoes,  soggy  bread,  corn-starch,  or  apple- 
dumpling  that  has  failed  to  kill  her  washerwoman's 
child.  Nature  has  so  provided  the  food  that  it  is  not 
all  concentrated  nourishment;  in  grain,  in  fruit,  in 
meat,  the  easier  digested  portions  have  with  them  cer- 
tain materials  that  are  harder  to  digest;  in  a  mixed 
diet  the  various  substances  have  different  degrees  of 
digestibility,  and  in  this  way  the  digestive  juices  come 
more  closely  in  contact  with  the  food,  owing  to  its 
bulk,  and  the  muscular  contraction  of  the  stomach  and 
intestines  is  promoted  by  the  mass  of  material  which 
passes  through  them.  It  would  be,  then,  a  mistake  to 
feed  a  person  in  health  entirely  on  concentrated  nourish- 
ment; the  intestinal  digestive  juices  would  fail  to  be 
secreted,  the  liver  would  become  congested  and  diseased, 
the  bowels  would  be  coated  with  mucus  and  would  fail 
to  act,  and  the  refuse  from  the  destruction  of  tissue 
which  is  carried  off  by  them  would  remain  behind  and 
poison  the  system.  But  during  illness,  when  digestion 
is  checked  and  when  it  is  necessary  to  supply  in  small 
amounts  the  most  concentrated  nourishment  to  sustain 
the  system  of  the  patient,  then  the  well-known  prepara- 
tions of  peptonized  foods,  of  concentrated  meat-extracts, 
are  not  only  most  valuable  but  often  absolutely  indis- 
pensable. 

After  it  has  cut  its  twelve  teeth,  the  child  will  natu- 
rally desire  a  greater  variety  of  foods,  and  within  bounds 
these  desires  may  be  satisfied.  Its  bill  of  fare  will  in- 
clude articles  that  are  easy  of  digestion, — mutton,  beef, 
sweetbread,  fowl  of  various  kinds,  soft-boiled  eggs,  eggs 
scrambled,  or  light  omelet;  vegetables,  as  cauliflower, 
young  beans,  beets,  potatoes, — the  latter  well  boiled 
and  mashed,  or  roasted, —  asparagus;  by  all  means 
avoid  parsnips,  cabbage,  turnips,  celery,  etc. ;  for  fruits, 


116  INFANCY. 

baked  apples,  raw  apples  scraped,  oranges — of  course 
only  the  juice,  grapes — avoiding  the  skins  and  seeds, 
peaches — provided  they  are  not  picked  green  and  then 
ripened, — and  avoid  berries  of  every  kind,  also  pine- 
apples, green  apples,  etc.  Figs,  dates,  and  raisins  are 
all  bad  for  children  at  this  tender  age. 

As  thorough  digestion  and  nutrition  require  fresh  air, 
mothers  should  bear  in  mind  the  importance  of  letting 
those  children  that  eat  heartily  keep  out  of  doors  as 
much  as  possible.  The  over-feeding,  even  with  nutri- 
tious food,  in  our  hot  American  houses  during  winter- 
time, is  undoubtedly  one  of  the  great  causes  of  disturb- 
ances in  the  liver  which  are  so  frequently  met  with.  It 
is  the  same  process  almost  that  is  used  in  the  making 
of  the  jpdte-de-fois-gras.  The  Strasburg  geese  are  over- 
fed and  over-heated.  Constipation,  which  is  so  com- 
mon in  these  bilious  children,  cannot  be  overcome  by 
laxatives  or  purgatives,  and  mothers  should  avoid  their 
use  or  their  abuse.  Let  a  bilious  child  be  allowed  to 
drink  water  freely,  to  have  a  good  run  in  the  open  air 
with  its  clothes  sensibly  loose,  ride  on  its  tricycle,  play 
with  its  hoop,  jump  rope, — the  biliousness  will  rapidly 
diminish  and  the  bowels  become  regular. 


CHAPTER   X. 

ON  THE  BOWELS. 


What  constitutes  a  Normal  Condition  of  the  Bowels  in  a  Child — 
More  Grease  than  Powder  should  be  used  for  Young  Children — 
What  causes  Disturbances  of  the  Bowels — Different  Causes  of 
Constipation — How  Constipation  can  be  overcome — Of  what  a 
Child's  Diet  should  consist,  and  how  it  can  be  regulated  when  it 
is  suffering  from  Bowel-Complaints— A  few  Useful  Bemedies — 
Exercise  a  Specific  for  many  Eorms  of  Constipation. 

It  is  a  very  important  matter  for  a  mother  to  know 
what  constitutes  the  normal  condition  of  the  bowels  of 


ON  THE  BOWELS.  117 

her  children.  At  birth,  the  intestines  contain  an  ac- 
cumulation which  is  carried  off  by  the  first  milk, 
this  milk  being  laxative  in  character.  The  passages 
will  then  assume  a  yellow  color,  and  in  about  two  or 
three  weeks  will  begin  to  get  gradually  solid,  in  part. 
The  passages  should  have  little  odor,  should  not  be 
sticky,  nor  contain  mucus,  and  should  be  liquid.  Up  to 
three  or  four  months  there  should  be  two  or  three  or 
even  from  four  to  five  movements  in  the  twenty-four 
hours ;  though  many  children  are  perfectly  healthy  who 
have  but  one  movement  in  the  twenty-four  hours  even 
at  this  tender  age.  As  soon  as  a  child  has  had  a  move- 
ment from  its  bowels  it  ought  to  be  changed,  and  it  is 
well  to  thoroughly  anoint  the  parts  with  vaseline ; 
anything  that  causes  irritation  of  the  skin — undue 
acidity  of  the  passages,  or  too  frequent  passages  from 
the  bowels — will  rapidly  cause  soreness,  unless  washed 
and  then  thoroughly  greased.  It  is  a  very  great  mistake 
for  mothers  to  use  rubber  or  oilcloth  with  the  diapers, 
as  these  will  draw  or  keep  the  parts  in  constant  perspira- 
tion. It  also  must  be  closely  watched  that  they  are  not 
washed  with  soda.  Grease  is  far  better  to  use  on  chil- 
dren's skin  than  powder.  A  little  white  vaseline,  as 
before  recommended,  tallow,  simple  cerate,  or  lanoline, 
will  make  the  best  ointment. 

As  the  child  grows  older  the  movements  become  less 
frequent ;  by  the  time  that  it  is  six  months  old  it  will 
have  about  two  passages  in  a  day.  These  passages,  of 
course,  are  not  always  exactly  the  same  for  a  nursing 
child  ;  indiscretion  on  the  part  of  the  mother,  the  use 
of  purgatives,  of  certain  articles  of  diet,  will  so  affect 
her  milk  as  either  to  cause  vomiting  or  purging  in  her 
infant.  The  child's  movements  may  vary  in  color,  be- 
coming greenish  or  variegated,  or  they  may  become  dark 
or  thin,  watery,  or  again  they  may  be  very  much  con- 
stipated, hard,  round,  surrounded  by  mucus,  or  again 
the  passages  may  be  white,  looking  like  pure  cheese. 


118  -  INFANCY. 

Constipation  may  be  evident  from  the  very  earliest 
movements  of  a  child's  life,  and  be  extremely  difficult 
to  overcome. 

We  will  study  the  two  conditions, — constipation  and 
diarrhoea, — and  endeavor  to  point  out  the  cause  and 
remedy  in  each  case.     Owing  to  the  smallness  of  the 
bowel  and  to  its  position  in  the  infant,  there  is  not  that 
accumulation  which  takes  place  in  the  adult,  in  the 
lower  bowel,  which  acts  as  a  reflex,  or  sympathetic,  irri- 
tant and  gives  occasion  for  the  muscle  to  contract  to 
have  a  movement.     This  reflex  irritation,  or  desire  to 
have  a  movement  of  the  bowel,  has  a  marked  tendency 
to  return  at  certain  hours, — that  is  to  say,  to  become  a 
habit, — and  when  properly  regulated  at  that  period  of 
a  child's  existence  when  the  habit  can  be  established, — 
when  the  child  is  a  year  old,  for  instance, — the  tendency 
which  might  have  existed  previously  to  constipation 
will  rapidly  disappear,  especially  as  from  this  time  for- 
ward the  child's  bowel  gradually  changes  its  condition 
and  allows  a  greater  distention  to  take  place.     Consti- 
pation in  the  infant  at  the  breast  is,  indeed,  one  of  the 
most  difficult  problems  to  solve  that  I  know  of;  at 
times  it  seems  to  be  a  hereditary  condition,  a  lethargy 
of  the  intestinal  nervous  system,  which  fails  to  respond 
to  irritation.     The  contents  of  the  bowel  are  composed 
of  many  materials  which  have  escaped  digestion,  curds, 
mucus,  the  secretions  which  have  been  thrown  into  the 
bowel  to  help  digestion,  or  to  lubricate  it;  the  secre- 
tions from  the  liver  especially,  which  are  intended  first 
to   help   digestion  by  aiding  the  absorption  of  fats, 
second  to  prevent   decomposition,  as  bile  is  a  great 
anti-putrefacient,  and  third,  the  bile  contains  the  re- 
fuse, the  ashes,  that  have  been  thrown  off  by  the  liver 
from  the  use  and  destruction  of  tissue.     These  mate- 
rials, if  not  thrown  off  by  the  liver,  are  poisonous,  and 
give  rise  to  the  symptom  known  as  biliousness.     Now, 
mothers  must  not  make  the  mistake  which  is  so  preva- 


ON  THE  BOWELS.  119 

lent  at  the  present  day,  to  imagine  that  constipation 
always  means  faulty  action  of  the  liver.  If  the  child 
is  constipated,  the  passages  white  or  chalky,  much  flatu- 
lence or  colic,  and  the  tongue  is  coated,  and  the  urine 
stains  the  diaper  with  a  reddish  hue,  then  there  is  a 
decided  want  of  action  of  the  liver,  and  the  constipation 
has  probably  a  cause  which  can  be  removed  by  appro- 
priate treatment ;  but  frequently  the  liver  itself  may  be 
working  perfectly  well,  while  a  catarrh  of  the  bowel,  a 
result  of  cold  or  indigestion,  may  be  seated  at  that  part 
where  the  bile  flows  from  the  liver  into  the  intestine, 
and  the  flow  of  bile  be  checked. 

The  symptoms  will  be  very  much  the  same  in  these 
'two  cases,  although  it  is  obvious  that  the  cause  is  dif- 
ferent, and  the  mother  who  recognizes  the  condition  but 
fails  to  grasp  the  difference  and  closes  her  child  without 
the  advice  of  her  physician,  may  do  an  immense  amount 
of  harm. 

It  is  on  this  account  that  throughout  this  little  work 
I  have  insisted  upon  submitting  all  such  matters  to  the 
family  physician.  I  am  opposed  to  household  works 
on  medical  treatment,  except  as  far  as  they  give  general 
information  and  are  part  of  a  liberal  education.  Every 
physician  knows  that  with  an  educated  mother,  who  is 
thoroughly  in  accord  with  the  doctor  in  his  endeavors  to 
understand  the  child's  condition  and  treat  it  properly, 
the  chances  of  success  are  greater  than  when  the  parent 
is  ignorant  of  those  many  details  which  works  of  this 
sort  impart. 

Constipation  may  be  due  to  the  character  of  the  food, 
to  the  want  of  secretion  in  the  intestine,  or  to  the  failure  of 
the  intestines  to  contract  and  propel  the  material  towards 
their  outlet, — what  is  known,  technically,  as  peristaltic 
action.  An  infant  at  the  breast,  or  bottle  especially, 
may  be  constipated  and  every  endeavor  fail  to  give  it 
regularity,  yet  as  soon  as  it  begins  to  take  solid  food  the 
bowels  will  immediately  become  normal.     A  mother 


120  INFANCY. 

should  recognize  these  different  conditions  in  order  to 
be  able  to  counteract  them.  If  the  constipation  depends 
on  the  character  of  the  food,  its  indigestibility,  or  the 
rapidity  with  which  the  water  is  absorbed,  leaving  an 
excess  of  solid  or  curds  behind,  the  movement  of  the 
bowels  will  be  of  cheesy  character,  putty-like,  the  masses 
hard,  lumpy,  possibly  not  differing  very  much  in  color 
from  what  they  ought  to  be,  but  they  are  surrounded 
by  mucus, — in  fact,  very  much  like  putty.  The  move- 
ments may  be  infrequent,  or  there  may  be  quite  a 
number  of  very  small  movements,  showing  an  irrita- 
bility of  the  rectum,  and  this  may  be  accompanied 
by  what  is  known  as  the  diarrhoea  of  constipation. 
This  form  of  bowel-trouble  is  found  especially  in  chilr 
dren  who  are  weaned  from  the  breast  and  who  are  on 
bottle-food,  and  its  treatment  is  to  give  freely  some  of 
the  broths,  such  as  mutton,  chicken,  or  beef,  a  cupful  or 
two  during  the  day ;  to  avoid  a  heavy  meat  diet,  or  one 
composed  exclusively  of  milk ;  to  give  the  child  its 
bowl  or  bottle  of  thin  boiled  bread  and  milk,  using  stale 
baker's  bread  and  straining,  and  making  it  thin  enough 
to  pass  through  the  nipple  of  the  bottle,  which  should 
be  made  larger  than  that  ordinarily  used.  The  child 
should  have  some  preparation  of  malt,  or  pepsin,  to  aid 
its  digestion.  A  teaspoonful  of  wine  of  pepsin  in  a 
claret  glass  of  water  immediately  after  eating  or  just 
before,  if  the  appetite  is  at  all  failing  ;  and  if  still  the 
masses  of  matter  passed  show  indigestion,  the  child 
should  have  about  ten  drops  of  the  aromatic  syrup  of 
rhubarb  with  five  drops  of  the  wine  of  ipecac,  every 
night,  in  a  claret  glass  of  water,  until  the  passages 
show  that  by  their  healthier  color  the  bile  is  being 
secreted.  If  the  digestion  seems  still  to  be  weak,  about 
half  a  teaspoonful  of  the  solution  of  lacto-peptine  can 
be  given  after  food. 

For  those  children  who  have  been  weaned  from  the 
bottle  and  are  taking  thicker  foods,  that  is,  solid  diet,  it 


ON  THE  BOWELS.  121 

is  a  mistake  to  give  water  too  freely  with  their  meals. 
The  water  should  be  given  between  meals,  as  in  that 
way  it  not  only  gives  water  to  the  system,  which  needs 
it,  but  it  washes  out  the  stomach  and  bowel  of  un- 
digested matter  and  mucus,  aids,  by  its  mechanical 
action,  the  passage  of  materials  which  should  be  dis- 
charged, and  relieves  constipation.  It  is  on  this  account 
that  a  glass  of  water  the  first  thing  upon  rising  in  the 
morning  is  recognized  as  a  laxative.  If  the  child  has 
much  straining,  it  will  be  noted  that  the  passages  are 
streaked  with  red  blood ;  this  is  caused  by  congestion  of 
the  mucous  membrane,  and  can  be  avoided  by  the  use 
of  some  soothing  enema.  A  small  hard-rubber  syringe 
holding  about  one  ounce  can  be  filled  with  the  follow- 
ing: 

Sweet  oil,  a  tablespoonful ; 
Warm  water,  100°,     " 
Pinch  of  salt. 

Mix  thoroughly. 

This,  given  to  the  child  at  the  time  when  its  bowels 
should  be  opened,  will  give  something  for  the  muscle  to 
contract  upon,  and  clear  the  mucus  out  of  the  lower 
bowel.  If  the  mucus  and  streaks  of  blood  still  remain, 
a  thin  starch- water,  boiled,  should  be  used  in  the  same 
way. 

Another  form  of  constipation  is  that  which  is  simply 
due  to  want  of  propelling  power  in  the  bowel.  In  these 
cases  a  child  will  go  for  several  days  without  a  move- 
ment, although  apparently  in  good  health ;  when  moved, 
the  passages  are  to  all  appearances  perfectly  normal, 
large,  well  formed.  It  is  astonishing  how  much  can 
accumulate  in  the  bowel.  Indeed,  it  is  probable  that 
most  of  the  over-fed,  fat  children  of  the  well-to-do  in 
our  large  cities,  who  take  little  exercise,  and  that  con- 
sisting of  a  daily  parade  with  the  nurse,  so  dressed  that 
it  is  impossible  they  can  take  the  exercise  required, 
v  11 


122  INFANCY. 

have  their  bowels  much  distended  with  matters  that 
finally  undergo  decomposition  and  are  the  causes  of 
the  blood-poisoning  which  foul  breath,  furred  tongue, 
loss  of  appetite,  languor,  drowsiness,  indicate,  all  grouped 
under  the  synonyme  of  biliousness.  These  flabby  chil- 
dren are  constipated  simply  through  want  of  propelling 
power  in  the  bowel  or  in  the  muscles  of  the  abdomen. 
For  these  the  treatment  is  generally  divided  as  follows : 
the  external,  the  dietetic,  and  the  use  of  medicines. 
The  external  treatment  consists  of  manipulating  or 
kneading  the  abdominal  wall.  As  this  condition  exists 
in  individuals  from  infants  at  the  breast,  we  might  say, 
until  old  age, — for  it  is  almost  as  common  with  the  parent 
as  with  the  children, — the  treatment  more  or  less  modi- 
fied is  useful  for  all.  The  child,  after  its  bath,  should 
be  placed  on  a  blanket,  on  its  back,  on  the  mother's  lap, 
and  the  abdomen  gently  rubbed,  beginning  by  placing 
the  palm  of  the  hand  upon  the  navel  and  rubbing  with 
a  circular  motion  gently  but  firmly  until  the  surface  is 
quite  in  a  glow,  each  movement  increasing  the  size  of 
the  circle,  like  the  rings  in  a  pond  after  a  stone  has  been 
thrown  into  the  water.  Soap  liniment  can  be  used,  or 
cod-liver  oil,  or  sweet  oil,  or  even  castor  oil,  externally, 
if  constipation  be  marked.  As  the  contents  of  the 
bowel  descend  on  the  left  side,  the  movement  should  be 
from  left  to  right.  One  good  rubbing  a  day  will  fre- 
quently be  followed  by  a  movement  of  the  bowels. 
This  may  be  still  further  increased  by  placing  the  hand 
in  the  same  way  and  shaking  the  abdomen.  Of  course, 
exercise  will  be  of  great  service  in  this  form  of  constipa- 
tion. For  an  infant  this  can  be  secured  by  gentle 
manipulation ;  for  an  older  child,  passive  exercise  and 
the  encouragement  of  out-door  sport. 

The  next  form  of  constipation  will  include  that  which 
is  due  to  derangements  of  digestion,  probably  produced 
by  too  highly  stimulating  food,  or  food  which  has  a  ten- 
dency to  ferment  and  produce  gases.     Mucus  will  be 


ON  THE  BOWELS.  123 

secreted  in  the  bowel  when  the  intestine  is  irritated 
by  food  or  cold,  and  instead  of  producing  diarrhoea, 
which  would  have  been  the  result  had  the  intestines 
been  inflamed,  may  cause  attacks  of  vomiting,  colic  from 
flatulence,  the  expulsion  of  gases  which  have  an  ex- 
tremely offensive  odor.  The  child's  abdomen  is  swollen 
with  wind,  and  the  passages  usually  are  offensive, 
possibly  fluid,  or  they  may  be  hard,  dark-colored,  and 
infrequent,  accompanied  also  by  a  coating  of  mucus. 
Children  that  are  fed  largely  upon  eggs  frequently  suf- 
fer in  this  way,  or  those  who  receive  a  large  amount  of 
starches  not  sufficiently  boiled,  which  remain  undigested 
in  the  bowel.  The  children  lose  their  appetites,  become 
peevish,  restless,  suffer  with  inordinate  distention  of  the 
abdomen,  and,  finally,  if  the  cause  is  allowed  to  con- 
tinue, get  catarrh  of  the  stomach  and  intestine,  and 
obstinate  diarrhoea  will  follow.  Of  course,  the  treat- 
ment in  cases  of  this  kind  is  obvious  ;  the  diet  should 
be  regulated,  and  such  harmless  laxatives  used  as  will 
relieve  the  child  of  the  offending  elements  and  re- 
establish its  digestion.  Stop  all  solid  food  for  a  day  or 
two,  also  milk  and  starches  ;  put  the  child  on  broths, 
and  give  it  a  dose  of  castor  oil,  a  teaspoonful  or  two. 
A  tablespoonful  of  liquid  soda-mint  can  be  made  quite 
warm,  castor  oil  mixed  with  this,  when  it  floats  to  the 
surface  it  can  be  readily  skimmed  off  and  given  to  the 
child  by  the  spoon.  Sweet  oil  can  be  used  in  this  way 
for  an  infant,  instead  of  castor  oil,  if  preferred.  If 
there  is  much  vomiting  in  these  cases  and  food  is  not 
tolerated,  such  as  broths  or  barley-water,  the  nourish- 
ment can  be  given  in  small  quantities,  using  Valentine's 
or  other  beef  extract.  Five  or  ten  drops  of  whiskey 
or  gin  in  warm  water  can  be  given  every  fifteen  or 
twenty  minutes,  or  two  or  three  drops  of  aromatic 
spirits  of  ammonia,  or  gum  arabic  water  and  lime-water 
can  be  used  for  a  time  until  the  vomiting  is  relieved. 
Dr.  Walker,  of  Brooklyn,  recommends  the  following : 


124  INFANCY. 

Creasote,  two  drops ; 
Glycerin,  two  teaspoonfuls ; 
Water,  a  small  tumblerful. 
A  teaspoonful  of  this  every  hour. 

And  if  there  is  much  colic,  he  advises — 

No.  1. 

Aromatic  catnip-tea,  two  tablespoonfuls ; 
Tinct.  asafoetida,  ten  drops; 
Syrup  (simple),  two  tablespoonfuls. 

Or  No.  2. 

Aromatic  spts.  of  ammonia,  fifteen  drops ; 

Essence  of  peppermint,  ten  drops ; 

Glycerin,  a  dessertspoonful ; 

Aniseed -water,  two  tablespoonfuls. 
A  quarter  to  half  a  teaspoonful  of  one  of  these  in 
water  every  fifteen  to  thirty  minutes  until  relieved,  if 
necessary. 

Use  hot  foot-baths  with  mustard  and  water,  and 
apply  mustard-poultices  containing  half  mustard  and 
half  meal  to  the  abdomen,  or  if  the  pain  should  still 
continue  an  enema  of  warm  water,  about  half  a  pint  or 
less,  or  one  of  hop-tea.  When  colic  and  constipation 
exist,  a  mother  should  never  give  a  purgative  without 
consulting  her  physician,  as  twisting  or  constriction  of 
the  bowel  may  be  the  cause,  but  recourse  can  be  had 
to  the  above-mentioned  treatment,  which  can  never  be 
harmful.  In  speaking  of  constipation,  I  may  also  men- 
tion the  fact  that  when  it  is  obviously  due  to  a  want  of 
expulsive  power  in  the  child  the  use  of  suppositories  is 
often  of  value,  and  when  cautiously  given  they  can  be 
used  for  some  months  until  the  child  has  gotten  into  the 
habit  of  having  the  bowels  moved  daily  at  the  same 
hour.  These  suppositories  can  be  made  either  of  Castile 
soap,  or  coca  butter ;  or  the  gluten  suppository  made  by 


ON  THE  BOWELS.  125 

the  Health  Food  Company  is  often  very  useful.  It  is 
a  mistake  to  give  a  child  laxatives  and  purgatives  as  a 
routine  practice.  Vary  the  diet ;  change  its  bottle-food 
from  one  thing  to  another ;  encourage  it  to  play;  give  it 
out-door  exercise.  These  will  often  in  themselves  be 
sufficient.  For  older  children  bran,  as  crackers,  is  often 
laxative,  or  it  can  be  made  into  bread  for  a  change. 


11* 


PART    III. 
CHILDHOOD. 

It  is  proposed  in  this  section  of  our  little  work  to 
give  to  mothers  and  nurses  a  plain  statement  of  the 
causes  and  method  of  nursing  of  the  more  important 
disorders  and  diseases  of  children.  By  disorders  we 
mean  simply  functional  disturbances;  by  diseases  we 
mean  those  disturbances  that  are  accompanied  by  some 
structural  changes. 

It  is  not  necessary  to  dwell  at  length  upon  the  ap- 
pearance of  a  sick  child.  We  have  endeavored  to  form 
a  picture  of  a  child  in  the  enjoyment  of  perfect  health, 
— an  infant  with  all  its  functions  working  in  perfect 
accord,  whose  sleep  is  soft  and  gentle,  who  awakes  bright 
and  cheerful,  who  eats  with  an  evident  relish  for  food, 
and  who  becomes  drowsy  as  digestion  begins ;  one  whose 
eyes  are  clear  and  bright,  its  skin  soft,  its  flesh  firm, 
bears  evidences  of  health.  But  when  the  child  becomes 
peevish,  restless,  or  drooping,  uneasy  after  eating,  start- 
ing in  its  sleep,  when  the  eyes  lose  their  brilliancy  and 
become  encircled  with  dark  rings,  its  skin  hot  and  dry, 
and  possibly  the  hands  and  feet  cold,  its  flesh  flabby 
and  soft,  and  the  rotundity  of  its  form  marked  by  a 
tendency  to  angularity,  showing  a  loss  of  the  cushions 
of  fat,  it  does  not  require  much  experience  to  recognize 
such  as  a  sick  child.  Whether  or  not  this  deviation 
from  health  is  simply  functional,  or  due  to  disease,  is 
not  the  question  we  have  to  deal  with  ;  that  rests  with 
the  doctor ;  but  as  he  depends  on  the  mother  for  a  true 
recital  of  those  symptoms  upon  which  he  bases  his  con- 
clusion, a  habit  of  accuracy  in  observation,  one  of 
126 


ACUTE  AND  CHRONIC  NASAL   CATARRH.     127 

thoroughness  in  investigation,  should  be  cultivated  by 
her.  This,  together  with  the  thorough  carrying  out  of 
all  the  details  of  treatment,  not  as  a  mere  machine  but 
as  an  intelligent  being,  one  who  is  capable  of  exercising 
judgment,  form  the  essentials  of  a  good  nurse,  and  this 
every  mother  should  seek  to  be. 


CHAPTER    XI. 

ACUTE  AND  CHRONIC  NASAL  CATARRH. 

Affections  of  the  Mucous  Membrane  of  the  Nose,  Acute  and 
Chronic,  in  Infants  and  Children  —  Their  Prevention  and 
Treatment. 

For  the  answers  to  the  following  questions,  which 
are  interesting  to  mothers  in  this  connection,  I  am  in- 
debted to  Dr.  Alexander  W.  MacCoy,  of  this  city. 

How  to  treat  an  ordinary  cold  in  the  head,  with  house- 
hold remedies  for  a  child  over  six  months  of  age  f 

A  cold  in  the  head  should  never  be  neglected.  At 
the  beginning,  an  attack  (ushered  in  by  fits  of  sneezing 
and  slight  feverishness)  can  often  be  arrested  before  the 
watery  flow  begins  by  the  prompt  use  of  quinine  suppos- 
itories, from  one-half  to  two  grains  each,  according  to 
age,  introduced  into  the  bowel  once  or  twice  in  the  day; 
also  small  quantities  of  sweet  spirits  of  nitre  in  iced 
water  (or  for  older  children  in  lemonade),  taken  freely. 
Sometimes  large  quantities  of  cold  water  taken  will  act 
so  promptly  on  kidneys  and  skin  as  to  quickly  relieve 
the  nose.  For  some  delicate  children  whiskey  and  water 
in  proper  doses  may  be  used.  Hot  (mustard)  foot-baths 
upon  retiring  is  a  time-honored  and  very  efficacious 
treatment  if  the  extremities  are  well  protected  during 
the  night.  If  the  nostrils  show  watery  and  mucous 
discharge,  the  nasal  chambers  should  be  looked  after,  and 


128  CHILDHOOD. 

the  stuffiness  and  stoppage  to  breathing  through  them 
must  be  combated  by  lubricating  them  within  with  bland 
oils  dropped  in  or  snuffed  up,  or,  better,  used  as  a  spray 
in  an  atomizer  or  vaporizer.  Fluid  cosmoline  is  one  of 
the  most  agreeable  and  effective  substances  available; 
combined  with  a  one-per-cent.  to  two-per-cent.  solution 
of  cocaine  it  is  most  efficient  in  relieving  the  nasal  distress 
and  stoppage  in  the  nostrils.  Plain  cosmoline,  warmed, 
and  applied  in  and  around  the  orifices  of  the  nostrils, 
will  greatly  add  to  the  comfort  and  repose  of  infants. 
Very  often  infants  suffer  more  from  the  accumulation 
and  adherence  of  the  secretion,  which  soon  dries  up  and 
renders  the  small  nasal  orifices  stiff,  uncomfortable,  and 
occluded.  The  frequent  application  of  a  weak  solution 
of  baking  soda  (bicarbonate  of  soda)  to  the  nostrils  on  a 
soft  rag  or  absorbent  cotton  will  easily  remove  this  dried 
secretion,  and  if  immediately  followed  by  the  free  use  of 
oil  or  cosmoline,  will  prevent  this  annoyance  from  re- 
curring. Guarding  the  child  from  over-heated  rooms 
during  the  day,  and  especially  at  night,  with  the  judicious 
use  of  quinine  suppositories  and  the  application  of  some 
oil  in  the  nose,  will  generally  relieve  and  cure  an  ordi- 
nary cold  in  the  head  in  one  or  two  days. 

1.  At  what  age  do  children  show  symptoms  of  chronic 
post-nasal  catarrh  f     What  are  its  earliest  symptoms  f 

The  time  at  which  a  discharge  from  the  head  occurs, 
either  from  the  nose  or  throat,  may  be  coincident  with 
the  child's  birth.  An  acute  cold  in  the  head  often  de- 
velops during  the  first  week  of  life,  and,  followed  by  a 
succession  of  other  attacks  during  the  earlier  months  of 
infancy,  may  give  rise  to  symptoms  of  chronic  nasal 
catarrh  as  early,  at  least,  as  the  first  year.  (Depending 
upon  some  hereditary  taint,  the  symptoms  are  familiarly 
known  as  "  snuffles,"  and  date  from  birth.)  A  post- 
nasal catarrh — a  dropping  of  mucus  or  phlegm  from 
the  head  into  the  throat — is  only  a  symptom  of  a  nasal 
catarrh ;  without  a  nasal  catarrh  existing  at  the  same 


ACUTE  AND    CHRONIC  NASAL   CATARRH.     129 

time  there  can  be  no  post-nasal  discharge.  It  is  prob- 
ably true  that,  in  young  children,  for  a  long  time  there 
is  no  actual  inflammation  behind  the  palate, — post-nasal 
space, — in  discharges  from  the  head  into  the  throat,  but 
the  secretion  comes  from  the  back  of  the  nose  and  slides 
down  the  palate  into  the  throat ;  the  throat  may  look 
red,  but  this  is  caused  solely  by  the  mucus  lying  there 
or  constantly  passing  over  it.  An  acute  cold  in  the 
head  will  give  rise  to  a  discharge  into  the  throat,  which 
in  children  will  be  much  more  noticeable  in  the  recum- 
bent position.  This  is  also  true  in  the  chronic  form. 
One  of  the  earliest  symptoms  manifested  in  an  infant  or 
child  suffering  from  nasal  catarrh  is  a  short,  irritative 
cough,  generally  very  persistent  and  occurring  chiefly 
at  night,  disturbing  the  child's  rest  to  a  distressing  de- 
gree. A  cough  arising  from  mucus  flowing  out  of  the 
back  of  the  nose  and  down  the  throat,  finally  tickling 
the  "  speaking-box"  (larynx),  is  not  amenable  to  ordi- 
nary treatment  by  cough-syrups,  etc.,  but  requires  the 
removal  of  the  secretion  from  nose  and  throat.  The 
cough  comes  on  generally  after  the  child  has  been  asleep 
for  some  time  and  the  recumbent  position  has  started 
the  secretion  downwards  in  the  direction  of  gravity. 
During  the  day,  the  usual  watery  or  mucous  discharge 
from  the  nose  is  seen,  and  frequent  attempts  at  swallowing 
may  be  noticed.  It  is  quite  unusual  for  parents  or  nurses 
to  give  much  consideration  to  a  cold  in  the  head,  and  it  is 
more  rarely  understood  that  this  disturbing  cough  at 
night  is  dependent  upon  the  state  of  the  nasal  passages. 
If  a  cold  in  the  head  is  overlooked  or  neglected,  as  is 
so  often  the  case,  the  constant  discharge  of  mucus  into 
this  space  behind  the  palate  and  its  continuous  flow  down- 
wards will,  in  time,  produce  an  enlargement  of  a  gland 
at  the  top  of  this  space  behind  the  palate,  as  well  as 
cause  a  pharyngitis,  which  gives  rise  to  a  serious  con- 
dition and  makes  what  is  often  called  "  a  weak  throat." 
And  the  trouble  does  not  end  here,  but  often  causes 


130  CHILDHOOD. 

change  in  the  voice,  rendering  it  husky  and  hoarse,  and, 
if  left  to  itself,  in  many  cases  causes  inflammation  of 
the  windpipe  and  also  of  the  bronchial  tubes  ;  and  in 
very  many  subjects  too  often  renders  them  weak-chested 
and  liable  to  acquire  some  grave  pulmonary  disease.  In 
the  space  behind  the  palate,  up  in  the  roof,  where  this 
gland  of  which  I  have  just  spoken  lies,  an  enlargement 
of  the  gland  develops  ;  in  some  cases  where  this  occurs 
the  tissue  hangs  down  over  the  nasal  openings  behind, 
and  causes  impeded  breathing  through  the  nose,  pro- 
ducing mouth-breathing,  and  causing  the  voice  to  become 
flat  and  nasal  in  character.  This  nasal  voice  is  also 
dependent  upon  obstruction  in  the  nasal  passages  them- 
selves, and  gives  the  true  explanation  why  we  are  said, 
as  a  nation,  to  "  talk  through  our  noses." 

2.  Are  there  any  'precautions  that  can  be  taken  to  pre- 
vent itf 

The  precautions  necessary  to  be  taken  to  prevent  a 
chronic  nasal  catarrh  are  comprised  under  the  hygiene 
of  infants  and  children,  and  the  adaptation  of  children, 
from  birth,  to  their  environments.  It  is  a  lamentable 
fact  that  infants  and  children  suffer  the  greatest  neglect 
of  proper  care  of  the  nasal  passages.  From  the  first 
bath  after  birth  onwards,  the  mucous  membrane  of  a 
child  is  put  on  the  defensive.  Too  frequent  bathing 
(daily)  of  infants  and  children,  with  much  too  warm 
water,  in  overheated  rooms,  followed  by  too  little  friction 
of  the  body,  is  a  fruitful  cause  of  "colds  in  the  head." 
The  important  task  of  bathing  is  generally  given  over  to 
the  "  child's  nurse"  after  the  first  few  months.  This 
position  is  frequently  filled  by  a  young  girl  remarkable 
chiefly  for  her  inexperience  and  stupidity.  The  little 
innocents  are  at  the  tender  mercies  of  such  persons,  not 
only  in  the  matter  of  bathing,  but  in  that  of  dressing, 
undressing,  proper  regulation  of  amount  of  bed-clothing, 
and  ventilation  of  the  bed-chambers.  If  the  natural 
guardians  of  children  would  give  more  attention  to  the 


ACUTE  AND   CHRONIC  NASAL   CATARRH.     131 

details  of  these  daily  matters  of  so  great  interest  to  the 
physical  welfare  of  their  offspring,  the  prevalent  nasal 
catarrh  would  become  much  less  frequently  seen.  Over- 
heated bedrooms  (furnace-heat  night  and  day)  and  too 
many  bedclothes  contribute  greatly  and  promptly  to  an 
attack  of  cold  in  the  head,  or  add  to  one  already  present. 
The  child,  after  being  asleep  for  one  or  two  hours,  is 
found  bathed  in  sweat;  such  discomfort  renders  it 
restless,  and  it  naturally  seeks  relief,  and  is  soon  outside 
of  the  coverings.  This  condition  of  affairs,  kept  up 
night  after  night,  soon  renders  the  skin  relaxed,  and 
greatly  enhances  the  risk  of  taking  cold  from  the  rapid 
evaporation  from  the  body.  The  selection  of  suitable 
bed-clothing  is  an  item  of  great  importance  to  the  child's 
welfare.  Light,  porous  blankets  are  the  only  bed-cover- 
ings advised.  Luxurious  eider-down  and  wool  comfort- 
ables, and  all  coverings  of  impervious  character,  are  to 
be  avoided.  Eider-down  is  especially  liable  to  be  used, 
because  of  its  light  weight,  when  the  atmospheric  con- 
ditions do  not  warrant  its  use.  It  is  only  suitable  for 
Arctic  climates  and  bedrooms  without  heat.  A  great 
amount  of  exercise  in  the  open  air  (life  in  the  country) 
is  one  of  the  best  preventives  of  nasal  catarrh. 

3.  Should  a  child  be  taught  to  blow  its  nose?  and 
should  water  be  snuffed  up  by  it  to  aid  it,  or  its  nose 
washed  out  with  a  spray  daily  f 

A  child  should  be  taught  to  blow  its  nose  if  done 
properly,  but  as  the  nose-blowing  is  generally  done  it  is 
conducive  of  harm  to  the  middle  ear,  and  is  thought  by 
some  to  greatly  increase  the  chances  of  earache  and  run- 
ning ear.  But  if  the  handkerchief  is  simply  placed 
under  the  nose  and  the  discharge  blown  into  it,  there 
can  only  good  results  follow,  viz.  :  emptying  of  the 
respiratory  tract  of  the  nose,  and  the  promotion  of 
free  nasal  respiration, — a  very  important  function. 
Water  should  never  be  snuffed  up  the  nose  by  children 
(or  adults),  except  in  case  of  nose-bleed,  as  it  is  apt  to  be 


1 32  CHILDHOOD. 

painful  and  also  bring  about  a  feeling  of  fulness  in  the 
nose,  and  thereby  increase  the  obstruction.  Water  well 
warmed,  and  containing  an  alkali  combined  with  carbolic 
acid,  may  be  employed ;  its  value  is  greatly  enhanced 
by  the  addition  of  glycerin.1  Used  in  the  form  of  a 
spray,  it  can  be  made  quite  efficient  in  dislodging  the 
retained  secretion,  cleansing  and  purifying  the  passages. 
Unless  the  discharge  is  profuse  and  purulent,  a  spray  of 
fluid  cosmoline  can  be  used  to  better  advantage,  often 
combined  with  some  drug  which  has  a  healing  action. 
This  simple  remedy  frequently  suffices  to  effect  a  cure. 

4.  If  a  child  snores,  can  it  be  prevented  f  Is  it  a  sign 
of  catarrh  ? 

This  question  may  be  answered  yes,  and  no.  If  a 
child  snores,  this  may  and  often  does  arise  from  obstruction 
to  nasal  breathing  produced  by  nasal  occlusion  in  vari- 
ous parts  of  the  canals.  It  also  very  frequently  arises 
from  enlargement  of  the  tonsils, — probably  the  next 
most  common  condition  causing  mouth-breathing  and 
rendering  snoring  possible.  There  are  some  cases  of 
snoring  in  children  that  do  not  arise  from  any  diseased 
condition  of  the  mucous  tract,  but  appear  to  come  on 
during  profound  sleep,  such  as  is  often  noticed  in  adults. 
Snoring  in  adults,  in  many  cases,  does  not  depend  upon 
any  obstruction  in  the  nose  or  throat ;  this  I  have  often 
verified  by  careful  inspection  of  subjects  given  to  snoring. 
The  prevention  of  snoring  which  is  dependent  upon  dis- 
ease will  only  be  successful  by  removing  the  cause, — re- 
moval of  all  obstruction  and  the  cure  of  mouth-breath- 
ing. 

5.  Should  a  child  that  hawks  or  snores  use  douche  or 
spray  f     If  so,  how  often,  and  what  to  use  with  it  f 

Very  young  children  never  hawk  ;  the  act  of  swallow- 
ing repeatedly  or  coughing  takes  the  f)lace  of  hawking, 
and  the  secretion  in  the  fauces  and  post-nasal  space  is 

1  Dobell's  solution,  with  a  Davidson  atomizer,  No.  63. 


ACUTE  AND   CHRONIC  NASAL   CATARRH.     133 

generally  swallowed,  as  in  infants.  A  nasal  douche 
should  never  be  used  for  a  child  except  in  cases  of  dry 
or  fetid  catarrh,  when  it  is  of  great  use  in  expelling  the 
retained  secretion.  A  douche  used  under  any  other 
circumstances  as  a  treatment  for  children  is  liable  to  do 
much  harm  to  the  middle  ear  and  increase  the  cold  in 
the  head.  As  said  before,  a  spray  can  be  used  with  ad- 
vantage, but  only  as  often  as  is  compulsory,  say  once  or 
twice  a  day,  and  even  then  the  mildest  solution  should 
be  used, — one  or  two  grains  to  the  ounce,  of  boracic  acid, 
chlorate  of  potassium,  in  glycerin  and  water,  or,  better, 
fluid  cosmoline  combined  with  borax  or  boracic  acid. 
Medication  of  the  nasal  chambers  can  be  very  efficiently 
instituted  by  the  use  of  the  "  Oliver  Vaporizer/'  using 
fluid  cosmoline  or  glycerin,  to  which  may  be  added 
such  drugs  as  are  suited  to  the  condition. 

6.  Please  give  all  the  best  methods  for  stopping  nose- 
bleed. 

Nose-bleeding  occurs  in  the  vast  majority  of  cases  in 
children  from  a  superficial  ulceration  on  some  portion 
of  the  middle  line  of  the  nose,  just  within  the  opening 
of  the  nostril.  This  abrasion  is  caused  from  picking 
the  nose,  the  finger-nail  or  handkerchief  scraping  off 
the  outer  layer  of  the  mucous  membrane.  This  super- 
ficial ulcer  on  the  middle  line  remains  unhealed  for  a 
long  time,  by  reason  of  the  free  motion  in  the  parts  in 
blowing  the  nose,  together  with  the  low  vitality  of  this 
thin  mucous  membrane  covering  the  cartilage.  Aside 
from  injuries  (falls,  blows,  and  sharp  substances  thrust 
up  the  nostrils),  the  ulcer  is  the  source  of  most  of  the 
nose-bleeds.  Blowing  the  nose  and  wiping  it  with  too 
much  vigor,  attacks  of  sneezing,  cough,  etc.,  also  bring 
about  the  flow.  Remembering  that  the  seat  of  the  bleed- 
ing is  very  low  down  in  the  nostril,  and  not  high  up,  as  is 
generally  supposed,  the  ease  with  which  the  hemorrhage 
can  be  arrested  by  a  little  pressure  will  add  greatly  to 
the  prompt  and  successful  treatment  of  these  attacks. 

12 


134  CHILDHOOD. 

The  finger  (if  child's  nostril  is  sufficiently  large)  can  be 
introduced  and  pressed  up  against  the  middle  line  of 
the  nose  for  a  sufficient  length  of  time  to  stop  the  bleed- 
ing. Then,  carefully  withdrawing  the  finger  and  pro- 
hibiting blowing  of  the  nose  will  often  be  sufficient. 
If  the  opening  of  the  nostril  is  too  small  to  allow  the 
finger  to  be  introduced,  enough  cotton,  wool,  or  soft 
sponge  can  be  pushed  into  the  orifice  to  slightly  distend 
the  nostril,  and  pressure  made  against  the  outside  of 
the  nostril  with  the  finger.  If  kept  up  long  enough 
this  will  often  succeed.  If  the  bleeding  has  been  great, 
or  long  continued,  saturating  the  cotton  with  some 
astringent,  such  as  a  weak  solution  of  alum,  tannin,  or 
tincture  of  iron,  will  cause  arrest  of  the  bleeding  much 
more  promptly.  Probably  the  most  satisfactory  astrin- 
gent to  use  on  cotton  is  the  watery  extract  of  witch-hazel, 
familiarly  known  as  "Pond's  Extract."  Saturating  the 
piece  of  absorbent  cotton  or  sponge  and  squeezing  out 
about  one-half,  then  introducing  into  the  nostril,  will  be 
immediately  successful.  If  there  should  be  too  much 
nervousness  to  try  the  introduction  of  any  of  these  sub- 
stances, a  simpler  plan  is  to  apply  ice  or  iced  water  to 
the  nose,  forehead,  or  back  of  neck  at  short  intervals. 
Cold  water  snuffed  up  gently  will  often  arrest  the 
hemorrhage,  or,  if  the  child  is  too  young  to  snuff  up 
fluid,  it  can  be  squirted  up  the  nostril  with  a  small 
syringe.  If  urgent,  extract  of  witch-hazel  had  better 
be  used,  and  it  will  be  with  the  happiest  effect.  It  can 
be  used  full  strength,  but  is  painful,  and  had  better  be 
diluted  with  water,  one-half  or  two-thirds  in  very  young 
children,  and  in  proportion  in  older  ones.  The  witch- 
hazel  is  in  most  cases  entirely  satisfactory,  but  if,  after 
all  these  methods  have  been  tried,  the  bleeding  con- 
tinues, a  surgeon  must  be  called  and  the  nostrils  plugged 
more  perfectly.  The  position  generally  assumed  in 
nose-bleed — that  of  holding  the  head  downward  over 
some  vessel — is  a  very  bad  one  and  should  be  avoided. 


DISEASES  OF  THE  tiAR  AND  EYE.  135 

The  head  should  be  held  erect,  and  the  blood  allowed 
to  flow  into  a  towel,  handkerchief,  sponge,  or  absorbent 
cotton.  To  make  a  permanent  cure,  the  ulcer — the 
cause  of  the  bleeding — must  be  removed.  This  will 
have  to  be  done  by  one  sufficiently  skilled  to  examine 
the  nose  carefully  and  treat  the  parts  intelligently.  The 
ulcer  is  often  slow  in  getting  well  unless  carefully  man- 
aged. If  the  nose- bleeding  arises  from  some  other 
cause,  or  during  an  attack  of  acute  illness,  the  nose 
should  be  promptly  examined  with  a  good  light  and 
the  cause  discovered  and  removed  by  the  surgeon.  At 
times,  in  children  of  plethoric  habit,  a  small  bleeding 
at  the  nose  need  not  make  the  parent  feel  anxious  at  all, 
but  it  may  be  looked  upon  as  simply  an  attempt  of 
nature  to  get  rid  of  too  much  pressure  in  the  blood- 
vessels. 


CHAPTER  XII. 

DISEASES   OE   THE   EAE  AND  EYE. 

Diseases  of  the  Ear  in  Infancy  and  Childhood — The  Care  of  the 
Ear  in  Childhood — Diseases  of  the  Eye  in  the  New-born — Treat- 
ment of  Simple  Ophthalmia — Contagious  Ophthalmia ;  how  to 
prevent  it ;  its  Treatment  and  Nursing. 

For  this  chapter  I  am  very  much  indebted  to 
Dr.  Charles  S.  Turnbull,  of  this  city. 

The  symptoms  of  earache  in  a  babe  would  lead 
those  who  are  used  to  children  to  suppose  that  some- 
thing irritated  and  troubled  the  child.  Except  slight 
fever,  more  or  less  restlessness,  rolling  of  the  head  from 
side  to  side,  perhaps  backward  burrowing  into  the  pil- 
low, nothing  is  noticed  until  the  attendant  reports  a 
"  running  ear."  The  drum,  or  middle  ear,  fills  with  a 
watery  fluid  (the  watery  part  of  the  blood,  serum),  or 
it  may  be  pure  blood,  and  this  subsequently  breaks 


] 36  CHILDHOOD. 

through  the  drum-nienibrane  and  escapes  from  the  ear. 
Often  the  perforation  heals  overnight,  and  apart  from 
the  staining  of  the  external  ear  from  blood,  or  the  coat- 
ing with  a  whitish  residue  from  the  serum,  nothing  is 
noticed.  The  perforation,  however,  does  not  always 
close.  Discharges  from  the  ear — caused  by  "taking 
cold" — behave  like  and  may  be  compared  to  the  dis- 
charge from  the  nostrils  under  similar  circumstances. 
The  secretion  is  first  water,  then  mucus,  then  thick, 
stringy  mucus,  then  matter,  and  last  of  all  badly- 
smelling  matter.  Such  discharge  from  an  ear  should 
only  be  carefully  wiped  out  with  plain  absorbent,  or 
borated  absorbent  cotton.  When  the  discharge  is  odor- 
ous the  doctor  must  be  called. 

If  a  babe  seems  to  have  earache,  until  the  doctor 
arrives  have  resort  to  the  hot  foot-bath,  and  use  dry 
heat  to  the  ear;  the  "hot- water  bag"  or  hot  salt  in 
flannel  bag.  The  doctor  will  prescribe  the  necessary 
medicines. 

"We  strenuously  object  to  the  use  of  drops  of  any 
kind,  or  water  dropped  or  syringed  into  the  ear. 
Fluids  so  used  make  an  ocular  examination  of  the 
ear,  on  the  part  of  the  doctor,  quite  impossible,  and 
syringing  macerates  the  parts  and  retards  the  sub- 
sequent healing  process.  Healthy  babes'  ears  always 
get  well  if  they  are  kept  clean  and  not  meddled  with, 
so  recollect  that  sins  against  the  ears  of  children  are 
more  usually  those  of  commission  than  of  omission. 
Teething  is  the  most  frequent  cause  of  earache  and 
running  ears.  Water  and  soap  we  consider  poisonous 
to  the  ears,  and  in  answer  to  the  query,  "  When  should 
running  ears  be  syringed  ?"  we  would  say,  "  Never." 

In  syringing  ears,  except  for  wax  or  foreign  bodies, 
there  is  great  danger,  especially  to  children,  from  impure 
water,  varied  temperature,  shortness  of  auditory  canal, 
peculiar  susceptibility  of  parts  from  anatomical  rela- 
tions, and  contiguity  of  brain. 


DISEASES  OF  THE  EAR  AND   EYE.  137 

Discharges  from  the  ear,  in  our  opinion,  unless  they 
are  sour  or  fetid,  may  be  regarded  as  harmless  in  so  far 
as  the  hearing  is  concerned. 

The  most  essential  point  in  the  cleansing  of  discharg- 
ing ears  is  the  thorough  freeing  of  the  inside  of  the  ear 
from  secretion.  This  must  be  done  by  teaching  adults 
Valsalva's  experiment, — making  forcible  expirations 
while  holding  the  nose  and  keeping  the  mouth  shut. 

Now,  how  can  this  all-important  process  be  accom- 
plished in  the  case  of  children?  In  only  one  way: 
by  forcible  inflation,  or  by  having  them  blow  their 
noses.  Every  child  should  be  taught,  if  possible,  to  blow 
its  nose.  If  it  has  not  been  or  cannot  be  taught  to  free 
the  nostrils  of  mucus,  its  chances  of  retaining  hearing 
power  in  case  of  disease  of  the  ear  are  much  poorer 
than  in  the  case  of  one  who  has  learned  to  blow  its 
nose. 

The  great  secret  in  the  successful  treatment  of  all  dis- 
charges from  the  ears  is  the  recognition  of  the  fact  that 
so  long  as  a  discharge  is  not  allowed  to  ferment,  it  will 
not  become  fetid,  seldom  even  purulent. 

As  soon  as  a  discharge  from  the  ear  makes  its  ap- 
pearance, something  is  invariably  dropped  into  it,  or,  in 
conformity  with  custom,  it  must  be  "syringed  out." 
Nothing  is  more  damaging  to  the  successful  termina- 
tion of  such  cases.  We  would  not  complain  if  pure, 
warm  water  were  used  to  syringe  the  ear,  or,  still  bet- 
ter, if  a  salty  or  an  alkaline  solution  were  used,  but  the 
"  Castile  soap"  is  invariably  added.  Perhaps  warm 
milk  may  be  used.  The  soapsuds  make  an  irritating 
solution,  the  milk  one  that  rapidly  ferments  and  be- 
comes acid,  so  that  the  auditory  canal — it  may  be  a 
warm  cavity  filled  with  simple  mucus  or,  perhaps, 
serum — is  converted  into  one  that  is  inflamed  and  filled 
with  fermenting  fluid.  What  next  is  done  ?  A  fluffy 
piece  of  cotton  is  rolled  into  a  dense  mass  and  stuffed 
into  the  auditory  canal.    The  sour,  fermenting,  perhaps 

12* 


138  CHILDHOOD. 

fetid  mass,  now  corked  up,  fairly  boils,  and,  where  a 
harmless  inflammation  was  in  existence,  an  active  and  a 
dangerous  one  has  certainly  been  started. 

To  remedy  aiFections  of  the  ear,  general  surgery  has 
done  but  little,  so  that  in  many  instances  medical  men 
are  glad  to  get  rid  of  "  patients  with  running  ears ;" 
and  this  added  to  the  prejudices  in  the  minds  of  the 
community  at  large,  and  in  some  of  the  profession, 
too,  as  to  the  injurious  effect  of  healing,  or  "  drying  up,". 
as  it  is  termed,  discharges  from  the  ear,  has  caused  this 
affection,  through  ignorance  or  apathy,  to  be  much 
neglected.  We  cannot  in  this  connection  omit  a  quota- 
tion from  Saunders/  who  tersely  ventures  a  question  or 
two  concerning  those  prejudices  which  even  to-day,  alas  ! 
are  urged  against  the  cure  of  running  ears. 

"  What  argument  can  be  assigned  against  the  cure  of 
this  disease  that  is  not  equally  conclusive  against  all 
others?  Is  any  one  an  abettor  of  the  obsolete  humoral 
pathology  ?  He  will  contend  that  the  stoppage  of  a 
drain  which  nature  has  established  is  pernicious,  and  the 
morbid  matter  will  be  determined  on  the  internal  parts  ; 
but  how  can  such  a  person  venture  on  the  treatment  of 
any  disease,  even  the  healing  of  a  common  ulcer  ?  Some 
years  ago  I  thought  this  absurd  doctrine  had  been 
totally  exploded,  and  yet  I  constantly  hear  it  adduced 
to  deter  parties  from  interfering  with  this  disease.  Is 
a  child  a  subject  of  it, — the  parent  is  told  it  is  best  to 
leave  it  to  nature,  and  the  child  will  outgrow  it.  Is  it 
an  adult, — some  other  subterfuge,  equally  futile,  is  em- 
ployed. The  truth  is,  the  disease  is  always  tedious  and 
difficult,  and  not  always  curable,  and  many  are  disin- 
clined to  embarrass  themselves  with  the  case,  who  have 
not  candor  to  make  the  true  statement." 

We  have  often  been  met  with  the  objection, — and, 

1 "  The  Anatomv  of  the  Human  Ear,"  etc.     John  C.  Saunders, 
M.D.,  London,  1806. 


DISEASES  OF  THE  EAR  AND  EYE.  139 

we  must  confess,  it  is  generally  well  put, — "  Why  dry 
up  the  purulent  discharge  from  the  ear,  since  when 
suppuration  is  actually  taking  place,  patients,  as  a  rule, 
hear  best  ?"  True  enough,  as  the  discharge  ceases  in  a 
case  of  discharging  ear,  hearing  power  is,  as  a  rule, 
materially  diminished  ;  but  we  always  make  reply  by 
asking  the  question,  "  Which  is  better,  half  a  loaf  or 
no  loaf  ?"  that  is,  to  stop  the  discharge  and  save  some 
hearing,  which  ivill  be  permanent,  or  allow  the  discharge 
to  continue,  and,  in  a  greater  or  less  time,  lose  all  hear- 
ing? Then,  too,  if  only  for  the  abolition  of  the  dis- 
gusting fetor  which  accompanies  such  cases,  if  for  noth- 
ing else,  it  is  well  worth  while  risking  any  fancied 
extension  of  the  inflammatory  process.  Children  with 
"  running  ears"  are  tabooed  by  their  class  and  playmates. 
Adults  are  tolerated,  while,  self-conscious  of  the  sicken- 
ing odor  from  their  ears,  they  shun  society,  and  imagine, 
not  without  good  cause,  that  everyone  is  aware  of  their 
infirmity.  The  majority  of  such  patients  are  generally 
willing  to  forego  the  greater  or  less  amount  of  loss  of 
hearing  power,  if  the  offensive  discharge  can  be  pre- 
vented. 

Beyond  a  doubt  a  discharging  ear  is  a  thorn  in  the 
flesh,  to  be  withdrawn  in  the  shortest  possible  time. 
Apart  from  the  risk  of  damage,  from  a  chronic  dis- 
charge from  the  ear,  to  the  hearing  and  subsequent 
happiness  of  the  individual,  is  the  undoubtedly  com- 
promised condition  of  the  unfortunate's  health.  Fetid 
discharges  run  down  into  the  throat,  and  poison  the 
system.  This  is  no  fancy  deduction,  but  a  fact.  By 
simple  cleansing  of  the  ears  and  teaching  our  patients 
how  by  Valsalva's  method  to  blow  the  pus  outward 
from  the  ear  into  the  canal,  which  we  keep  thoroughly 
cleansed,  we  have  met  with  most  pleasing  results  in 
these  same  children,  who,  from  pale  and  emaciated 
subjects,  have  grown  into  fat  and  ruddy  specimens  of 
humanity. 


140  CHILDHOOD. 

Again,  we  are  often  confronted  with  the  objection 
that  "  if  these  discharges  from  the  ear  should  be 
stopped,  the  disease  will  go  to  the  brain."  How  did 
this  idea  originate?  Because  heretofore  such  heroic 
measures  were  used  to  check  the  discharge,  because 
such  caustic  solutions  were  poured,  and  powders  were 
insufflated,  into  the  ears ;  furthermore,  because  no  in- 
telligent treatment  was  employed.  In  the  majority  of 
cases  no  careful  ocular  inspection  of  the  parts  was  ever 
made,  and  extension  of  inflammation  and  disease  to  the 
inner  ear,  or  even  brain,  resulted. 

The  majority  of  cases  of  running  ears  in  children 
under  two  years  of  age  would  recover,  and  the  hear- 
ing would  not  be  damaged,  if  they  were  simply  let 
alone. 

Now,  this  statement  may  seem  startling,  but  it  is 
nevertheless  true.  Ordinary  cleanliness  is  all  that  is 
necessary  for  the  proper  management  of  such  cases. 
In  the  use  of  medicated  solutions  to  be  dropped  into 
the  ears  of  children,  the  anatomy  of  the  parts  must  be 
understood.  The  auditory  canal  is  short  and  the  Eu- 
stachian tubes  are  patulous,  and  the  solutions  dropped 
into  the  discharging  ears  of  children  run  directly  into 
the  throat.  For  this  reason,  if  for  no  other,  the  syringe 
should  not  be  used. 

Admitted  that  nothing  but  pure  water  has  been  used, 
even  this  is  too  irritating  for  the  ear,  Eustachian  tubes, 
and  fauces  (it  must  not  be  forgotten  that  the  mucous 
membrane  or  lining  of  the  drum  or  middle  ear  serves 
the  purpose  of  periosteum,  the  same  membrane  that 
covers  and  nourishes  the  bone).  Those  who  have  acci- 
dentally gotten  water  up  the  nose  will  recall  its  un- 
pleasant irritating  effect. 

After  scarlet  fever,  measles,  chicken-pox,  bronchitis, 
etc.,  dentition  or  cutting  teeth  is  the  most  fruitful  source 
of  running  ears,  and  the  tendency  of  all  such  cases  is  to 
recover,  without  damage  to  hearing,  providing  they  be 


DISEASES  OF  THE  EAR  AND  EYE.  141 

kept  clean  and  nature  be  given  a  chance.  How  should 
the  ears  be  kept  clean  ? 

We  want  to  impress  upon  parents,  and  those  who  are 
to  advise  them,  the  necessity  of  using  the  utmost  care  in 
the  art  of  cleansing  the  ears  of  children.  Wax  (ceru- 
men), with  which  nature  has  furnished  the  auditory 
canal,  is  usually  swabbed  out  weekly,  if  not  oftener, 
with  a  twisted-up  corner  of  a  towel,  handkerchief,  or 
wash-rag  soaked  with  water  or  soapsuds ;  and,  more  fre- 
quently than  is  supposed,  a  pin  or  the  hair-pin  is  called 
into  requisition.  By  these  means  the  wax  is  pushed  in 
and  well  rammed  down,  layer  after  layer,  and  at  each 
washing  a  layer  of  desquamating  epidermis  is  added  (as 
is  the  cow's  hair  to  the  mortar),  and  this  serves  to  bind 
the  mass  together  and  make  its  removal  more  difficult. 

Masses  of  wax  or  dried  skin,  in  fact,  all  sorts  of 
foreign  substances,  pushed  into  the  ear  by  unsuccessful 
attempts  at  cleansing  with  the  wash-rag,  etc.,  or  foreign 
bodies  designedly  placed  in  the  ears  by  children,  are 
often  the  cause  of  a  most  distressing  cough,  for  which 
the  little  patient  is  mercilessly  dosed.  To  the  experienced 
the  peculiar  spasmodic  ear-cough  can  be  recognized,  and 
observant  children  often  complain  of  a  sticking  or 
irritation  below  and  behind  the  angle  of  the  jaw,  which 
symptom — and  perhaps  accompanying  deafness — must 
point  to  the  ear  as  a  cause. 

Children  naturally  rebel,  and  interference  with  their 
ears  is  generally  a  cause  for  war  in  the  nursery ;  and  it 
is  just  here  that  we  wish  to  put  in  a  plea  for  the  juve- 
niles, and  condemn  the  usual  practices  of  the  best- 
intentioned  of  nurses  and  mothers. 

With  but  a  few  exceptions,  impacted  wax  in  adults  is 
found  only  in  the  ears  of  those  who  vigorously  use 
water,  soap  and  water,  or  wet  cloths,  to  cleanse  their 
ears  from  what  they  call  dirt,  and  what  we  must  re- 
cognize as  absolutely  essential  to  perfect  hearing  and 
a  healthy  condition  of  the  ears. 


] 42  CHILDHOOD. 

Impacted  wax  must  be  first  soaked  by  the  instillation 
of  a  warm  alkaline  solution,  and  then  can  always  be 
safely  removed  by  syringing  with  warm  water,  which 
procedure  is  the  only  one  in  which  we  consider  the  use 
of  water  permissible ;  even  here,  however,  had  water 
not  been  injudiciously  used  in  the  first  place,  the  wax 
would  never  have  become  packed. 

In  case  it  becomes  necessary,  for  superfluous  wax  or 
the  lodgement  of  dust,  to  wipe  out  the  meatus,  it  should 
be  done  with  a  dry,  soft  cloth,  or  a  damp  towel. 

About  foreign  bodies  in  the  ear. — Children  seem 
especially  possessed  with  a  suicidal  mania  for  placing 
buttons,  beads,  seeds,  pebbles,  etc.,  into  their  ears,  and 
the  majority  of  doctors  are  prone  to  attempt  to  spoon, 
gouge,  or  dig  them  out.  Whosoever  attempts  the  re- 
moval of  any  foreign  body  from  the  ear  of  a  child  by 
other  means  than  the  syringe  and  warm  water,  and,  if 
the  child  be  frightened,  without  the  use  of  an  anaesthetic, 
certainly  shows  great  want  of  experience,  or  heed  to 
the  warning  of  those  who  can  advise. 

Now  that  we  have  the  petroleum  products  vaseline, 
cosmoline,  and  fluid  cosmoline,  all  of  which  have  the 
charming  recommendation  of  never  fermenting,  the  oils 
usually  distilled  must  be  omitted,  because  such  vegeta- 
ble products  as  olive  and  almond  oils  act  sooner  or  later 
as  irritants. 

We  never  use  anything  else  to  drop  into  the  ear, 
except,  for  larger  children  and  adults,  the  following, 
which  Ave  would  call  "earache  drops"  (the  aromatics 
contained  preventing  the  small  proportion  of  almond 
oil  from  fermenting)  : 

R  Cocaine  muriate,  two  grains  ; 

"  Baume  Tranquille,"  three  drachms. 

We  direct  a  few  drops  into  the  ear  with  glass  dropper, 
previously  dipped  in  hot  water. 

Babes  should  always  wear  an  under  flannel  cap,  and 


DISEASES   OF  THE  EAR  AND   EVE.  143 

larger  children  should  wear,  during  the  cold  weather, 
caps  which  may  be  made  of  any  warm  material  to  suit 
the  taste,  but  they  should  tie  under  the  chin  and  pro- 
tect the  ears. 

Too  frequently  warm  caps  are  worn  during  the  week, 
while  on  Sunday,  as  well  as  on  high  days  and  holidays, 
a  gorgeous  hat  is  substituted  which  leaves  the  head  un- 
protected. 

Especially  necessary  is  the  warm  cap  for  a  child  who 
has  suffered  from  ear-diseases.  On  no  account  should  cot- 
ton ever  be  worn  in  the  ears.  Why  ?  Because  it  acts  like 
a  cork  and  prevents  the  ventilation  of  the  ears,  and  acts 
only  as  an  irritant.  If  a  discharge  be  present,  the  plug 
will  induce  fermentation  and  offensive  odor. 

A  child  with  a  running  ear  can  go  out  of  doors  in  cold 
weather.  Unless  there  be  actual  pain  present  or  com- 
mencing inflammation  of  the  ears,  a  child  should  be 
warmly  dressed  and  sent  out  just  as  usual.  Housing 
of  children  with  running  ears  is  more  apt,  by  engen- 
dering ill  health  and  disordered  digestion,  to  do  harm 
rather  than  good.  If  the  feet  are  kept  dry  and  warm, 
fresh  dry  air  is  to  be  specially  recommended  with  out- 
door exercise. 

Look  upon  water  and  glycerin  and  the  much-extolled 
and  detestable  Castile  soap  solutions  as  irritant  poisons, 
and  taboo  them,  at  our  recommendation,  as  worse  than 
useless.  So  also  must  we  protest  agaiust  the  use  of  oils 
other  than  vaseline  or  cosmoline,  because  they  become 
rancid. 

In  conclusion,  allow  us  to  say, — 

For  collections  of  wax  in  the  ears,  soak  and  syringe. 

For  pain  in  the  ears,  use  dry  heat  and  anodynes  in 
full  doses. 

For  children's  earaches,  never  forget  the  hot  foot-bath 
and  aconite.  Tincture  of  iodine  behind  the  ears  is  less 
annoying,  and  does  just  as  well  for  counter-irritation  as 
a  blister. 


144  CHILDHOOD. 

Wipe  out  running  ears  with  absorbent  cotton,  and  do 
not  meddle  too  much  with  new  cases. 

Tickling  under  the  angle  of  the  jaw  on  either  side, 
with  sudden  impairment  of  hearing,  means  irritation, 
and  calls  for  special  treatment. 

Old  cases  of  running  ears  call  for  an  aurist's  advice. 
Never  plug  discharging  ears  with  cotton.  Never  pick 
the  ears  with  anything  smaller  than  the  finger. 

Given  a  case  of  deafness  in  an  adult,  insist  on  "Val- 
salva's experiment.  Given  a  case  of  deafness  in  a 
child,  insist  upon  its  frequently  blowing  its  nose  or 
else  forcibly  inflate,  for  it,  the  middle  ears. 

We  have  had  particular  reference  to  diseases  of  the 
ear  in  children,  and  have  confined  ourselves  to  the  study 
of  the  hygiene  and  practical  common- sense  treatment 
such  as  experience  leads  us  to  commend. 

In  prescribing  for  the  ear  entirely  too  much  guess- 
work is  indulged  in,  and  by  waiting,  too  much  precious 
time  is  lost. 

It  is  recklessness — and  this  is  putting  it  very  mildly 
— to  prescribe  for  an  ear  without  first  having  made  a 
careful  examination  of  it,  and  he  who  orders  anything 
to  be  dropped  into  the  ear  before  making  an  ocular  ex- 
amination of  the  canal  is  not  to  be  trusted. 

DISEASES   OF   THE    EYES. 

Let  us  consider  the  nursing  of  diseases  of  the  eyes  in 
infants  and  children. 

To  the  laity  almost  all  inflammations  of  the  eyes  of 
new-born  babes  are  known  as  "ophthalmia,"  but  we 
want  to  specify  and  say  that  physicians,  in  a  general 
way,  recognize  two  forms.  One  caused  by  cold — the 
harmless  variety — can  be  easily  cured  by  careful  cleans- 
ing and  the  use  of  astringent  washes,  such  as  rose-water 
or  alum  or  borax  (one  grain  to  the  ounce).  The  other, 
a  most  dangerous  and  easily  contracted  disease,  threatens 
blindness.     This  latter  form  is  not  apt  to  spread  among 


DISEASES   OF   THE  EAR  AND  EVE.  145 

careful  people,  at  their  homes,  but  at  a  public  institu- 
tion unless  isolated  at  once,  will  be  sure  to  sweep 
through  and  attack  every  child  in  it. 

If  asked  how  a  baby's  eyes  should  be  treated  im- 
mediately after  birth,  we  would  say,  certainly  not  to  a 
dose  of  soapsuds  in  the — to  be  condemned — popular 
primary  scrubbing  with  which  many  a  poor  babe  is 
tortured.  The  bad  colds  (snuffles)  which  attack  such 
over-scrubbed  babes  affect  the  eyes,  as  well  as  the  nose 
and  throat,  and  often  alarm  the  medical  attendant  and 
worry  the  mother  and  nurse. 

If,  as  in  such  cases,  the  eye  looks  red  and  the  secre- 
tion be  gummy  and  sticky,  like  the  white  of  an  egg,  or 
if  a  yellowish-white  discharge  be  present,  gathering  in 
the  corner  of  the  eye,  or  perhaps  gumming  the  lids 
together,  a  soothing  eye-wash  composed  of 

R  Borax,  five  grains  ; 

Paregoric,  one  teaspoonful ; 

Infusion  of  sassafras-pith,  eight  tablespoonfuls, 

should  be  frequently  applied  with  a  soft  piece  of  old 
linen,  and  about  twice  day  a  few  drops  may  be  allowed 
to  run  between  the  open  lids. 

Should,  however,  the  eyelids,  within  the  first  twenty- 
four  hours,  pun0  up  and  swell  so  that  the  eye  cannot 
be  opened,  and  particularly  should  the  secretion  oozing 
from  between  the  lids  be  creamy  and  of  a  yellowish, 
pinkish,  or  greenish  color,  then  look  out ;  the  dread 
ophthalmia  has  started. 

This  disease,  which  contributes  so  largely  to  the  blind 
in  our  asylums,  calls  for  the  most  heroic  treatment  on 
the  part  of  the  medical  attendant,  and  eternal  vigilance 
on  the  part  of  the  nurse.  At  this  juncture  both  phy- 
sician and  nurse  must  incessantly  and  conservatively, 
yet  resolutely,  attack  the  disease,  and  unceasingly  fight 
night  and  day. 

The  swelling  and  inflammation  must  be  combated  by 
Q        k  13 


146  CHILDHOOD. 

cold  applications,  day  and  night,  made  by  means  of 
small  pledgets  of  linen,  which  are  lifted  cold  and  wet 
from  a  block  of  ice  and  laid  upon  the  eye,  but  be  careful 
that  they  cover  no  more  than  the  burning  eyelids.  These 
pledgets  will  be  required  to  be  renewed  frequently,  at 
intervals  of  from  fifteen  to  twenty  minutes.  The  lids 
at  the  same  time  must  be  gently  separated,  and  the  dis- 
charge allowed  to  escape,  or  be  carefully  wiped  away 
with  pieces  of  absorbent  cotton  dipped  in  fresh  water 
or  salt  or  borax  to  make  a  weak  solution. 

If  the  doctor  be  willing  to  personally  supervise  the 
daily  preparation  of  a  gallon  or  more  of  corrosive- 
sublimate  wash  (1  part  to  6000),  nothing  could  be 
better.  Sponges  are  dangerous.  Use  absorbent  cotton, 
as  it  is  clean  and  can  easily  be  disposed  of. 

Great  care  must  be  exercised  that  the  cold  applications 
be  not  kept  up  too  long, — i.e.,  without  intervals  of  a 
few  minutes'  rest,  say  fifteen  minutes  every  two  hours. 
Be  careful  also  about  the  ears,  and  see  that  no  water 
trickles  into  them  ;  also  see  that  the  hair  be  kept  dry, 
and  the  pillow  as  well ;  and  be  most  particular  that  the 
patient's  and  attendants'  hands  are  kept  clean  and  never 
put  near  the  face,  always  regarding  the  discharge  and 
every  sort  of  eye-wash  used,  as  rank  poison. 

So  long  as  the  discharge  be  creamy  it  must  be  con- 
sidered as  corrosive  (like  acid  or  vitriol) ;  and  it  is 
during  the  first  stage,  when  the  swelling  is  so  great  that 
the  lids  cannot  be  opened,  that  the  following  injection, 
to  be  repeated  every  three  hours,  must  be  gently  squirted 
(with  a  round-ended  medicine  dropper)  from  the  inner 
(nasal)  angle  of  the  fissure  between  the  eyelids  : 

B  Sulphate  of  morphia,  two  grains ; 
Chloride  of  zinc,  two  grains ; 
Rose-water,  ten  drops ; 
Distilled  water,  five  tablespoonfuls. 

Now,  recollect    such   eyes  cannot  be  watched   and 


DISEASES   OF  THE  EAR  AND  EYE.  147 

cleansed  and  treated  up  to  bedtime,  and  then  neglected 
because  the  baby  or  its  attendants  sleep.  Oh,  no,  lest 
the  little  one's  eyes  melt  away  during  the  night.  Long 
naps  are  not  desirable,  either  in  the  case  of  children  or 
nurses,  as  a  good  night's  rest  has  cost  many  an  eye.  We 
repeat,  the  treatment  must  be  kept  up  night  and  day. 
We  have  said  the  secretion  is  corrosive  in  its  action  upon 
the  structures  of  the  child's  eyes,  and  as  the  eyeball, 
from  pressure  of  swelling,  is  damaged,  the  discharge  is 
doubly  fatal.  Then,  too,  the  child  might  turn  in  bed, 
and  the  discharge,  by  gravity,  would  run  into  and 
inoculate  the  fellow-eye.  Yes,  this  is  not  all ;  it  is 
deadly  poison  when  transplanted  to  any  other  person's 
eye,  and  nurses,  mothers,  and  medical  attendants  cannot 
be  too  careful.  Even  the  poor  laundress  often  becomes 
a  victim,  and  this  poison  has  too  often  been  the  cause 
of  the  loss  of  valuable  eyes,  to  which,  through  igno- 
rance or  carelessness,  it  has,  by  touch  only,  been  con- 
veyed. Keep  the  poor  little  one's  excoriated  cheeks  and 
skin,  worn  out  by  washing,  well  anointed  with  vaseline. 
.  So  also  the  edges  of  eyelids,  nose,  and  nostrils.  Keep 
pledgets  of  cotton  (not  absorbent  cotton)  in  the  ears. 
Keep  the  strength  up,  and  give  cooling  medicines  such 
as  the  usual  fever  mixtures,  nitre,  quinine,  and  aconite. 
The  baby's  sleep  will  be  greatly  disturbed,  its  nerv- 
ous system  racked,  it  may  take  cold,  it  may  become  sick, 
it  may  die  from  irritation  and  exposure.  Take  the 
risk,  and  if  you  falter  in  accepting  the  odds,  think  of 
the  heart-rending  appeal  of  a  pair  of  sightless  orbs. 
Think  that  the  flaxen-haired  girl  is  to  be  a  "  blind 
Nydia,"  or  the  boy  a  dependent,  helpless  man.  We  are 
emphatic,  because  we  have  seen  the  deplorable  ravages 
of  the  disease  we  have  but  partially  described,  so  we 
urgently  warn  you  to  immediately  care  for  it,  and 
promptly  seek  counsel  and  experience  to  fight  this  dread- 
ful disease.  It  blinds  individuals  in  families,  it  blinds 
our  children  in  our  asylums,  and  two  and  three  at  a 


148  CHILDHOOD. 

time ;  it  blinds  grand  nurses,  loving,  faithful  Sisters  of 
Charity,  and  even  prominent  and  skilful  physicians. 

Unless  a  physician  be  at  hand  to  apply  such  local 
remedies  himself,  we  consider  it  criminal  to  recommend 
or  order  caustic  solutions  to  be  dropped  into  the  eyes. 
The  physician  only  can  turn  the  lids,  brush  over  any 
caustic  solution  necessary,  and  immediately  (for  fear  of 
over-effect)  wash  it  off  again ;  but  stronger  applications 
than  those  we  have  named  are  not  to  be  recommended 
for  home  use. 

We  have  only  referred  to  the  treatment  of  individual 
cases  at  home.  In  asylums,  where  infants  are  brought 
in  daily,  we  insist  upon  immediate  isolation  of  the  child 
as  well  as  its  attendants  and  their  wash.  If  the  disease 
be  progressing  to  a  favorable  termination  the  discharge 
will  become  less,  the  swelling  of  the  lids  will  diminish, 
and  the  child  will  be  able  to  open  its  eyes.  At  this 
stage  we  commence  the  use  of  a  slightly  stimulating 
salve : 

B  Yellow  oxide  of  mercury,  one  grain  ; 
Vaseline,  three  drachms. 

To  be  rubbed  on  the  edges  of  the  eyelids  about  three 
or  four  times  a  day,  or  just  before  the  babe  goes  to 
sleep.  Beyond  this  we  cannot  advise  any  other  treat- 
ment save  that  which  your  medical  attendant  may 
order. 

We  would  in  this  disorder  make  an  exception,  and 
say  that  without  medical  advice  and  guidance  "  oph- 
thalmia in  the  new-born"  must,  as  a  rule,  mean  blind- 
ness, whether  of  one  or  both  eyes.  In  the  contagious 
ophthalmia  of  asylums,  where  one  sore-eyed  baby  poi- 
sons the  rest  and  where  simple,  yet  decided  local  treat- 
ment is  required,  we  particularly  commend  a  peculiar 
compound  called  fifty  per  cent.  "  boro-glyceride."  This 
is  made  by  boiling  together  boric  acid  and  glycerin — 
sixty-two  parts  of  the  former  to  ninety-two  parts  of  the 


DISEASES  OF  THE  EAR  AND  EYE.  149 

latter — until  the  product  loses  weight  and  weighs  but 
one  hundred  parts.  This  in  cooling  resembles  in  con- 
sistency and  appearance  ice  or  "glacial  phosphoric" 
acid,  and  is  found  to  be  very  hygroscopic.  To  dilute 
it,  glycerin  must  be  employed,  and  the  best  method  for 
its  preparation  is,  when  freshly  made,  to  add  to  it  gly- 
cerin in  such  proportion  as  to  make  a  fifty-per-cent. 
solution.  This  makes  a  preparation  of  the  consistency 
of  honey,  to  which  can  be  added  iodine,  tannin,  resor- 
cin,  carbolic  acid,  iodoform,  morphia,  atropia,  eserine, 
etc.,  as  may  be  desired.  The  ointment  of  boro-glycer- 
ide  is  made  after  the  following  formula : 

R  Sol.  boro-glyceride,  fifty  per  cent.; 
Vaseline,  six  drachms ; 
Oil  of  rose,  q.  s. 

This  makes  a  thoroughly  stable  ointment  which 
neither  becomes  granular  nor  precipitates  the  boric 
acid.  We  feel  confident  that  in  this  compound  we 
have  a  most  valuable  remedy,  and  when  called  upon 
to  combat  the  appalling  epidemic,  such  as  often  occurs 
in  our  asylums,  we  feel  much  more  secure — especially 
in  the  case  of  young  children — when  using  this  excel- 
lent remedy.  The  fifty  per  cent,  boro-glyceride,  on 
account  of  the  great  affinity  of  the  solution  for  water, 
and  the  rapidity  with  which  it  absorbs  it  and  liberates 
the  finely  subdivided  particles  of  boric  acid,  not  only 
acts  as  an  astringent  but  also  as  an  antiseptic.  We 
believe  it  is  just  the  substance  that  we  are  in  need  of 
for  the  treatment  of  all  forms  of  chronic  inflammations 
of  the  eye,  especially  "  contagious  ophthalmia." 

The  use  of  the  ointment  mentioned  we  consider  an 
essential  part  of  the  boro-glyceride  treatment,  and  it 
must  be  continued  for  at  least  two  months  after  all 
discharge  has  ceased. 

This  disease,  like  every  form  of  ophthalmia,  is  only 
13* 


150  CHILDHOOD. 

transmitted  by  inoculation,  and  under  proper  care  need 
not  be  transmitted  to  the  fellow-eye. 

What  is  proper  care?  Proper  care  is  two  skilled 
and  trusty  nurses,  the  one  for  the  day,  the  other  for 
the  night,  who  never  leave  the  patient;  or,  as  an  extra 
precaution,  better  say  four,  so  that  one  of  the  two  on 
duty  will  be  sure  to  keep  awake. 

As  soon  as  the  little  sufferer  shows  the  least  tendency 
to  open  its  eyes,  it  should  be  encouraged  in  its  endeav- 
ors. Darken  the  room  moderately,  so  that  the  influ- 
ence of  bright  light  does  not  make  it  shrink.  The 
opening  of  the  eye  is  beneficial  in  two  ways, — the 
movements  of  the  lids  work  the  corrosive  secretion 
out  from  between  the  eyelids,  and  they  stimulate  the 
circulation  in  the  affected  parts. 

When  a  child  opens  its  eyes  the  danger  is  over,  only 
a  relapse  must  not  be  allowed  to  occur.  The  iced  ap- 
plications have  only  to  be  continued  until  the  swelling 
of  the  lids  and  the  creamy  character  of  the  discharge 
have  disappeared.  No  child  need  lose  its  eyes  from 
ophthalmia,  and  no  child  does,  if  faithfully  treated  in 
the  way  just  described. 

Knapp  says  he  is  convinced  that  nothing  is  so  pow- 
erful in  diminishing  the  violence  of  this  dreadful  in- 
flammation as  cold,  and  he  is  afraid  that  warmth  may 
temporarily  increase  it  and  favor  destruction  of  the 
eye;  and  says  furthermore,  among  all  questions  in 
ophthalmology — that  of  cataract,  perhaps,  excepted — 
there  is  none  so  important  as  the  treatment  of  "  con- 
tagious ophthalmia." 


DISEASES  OF  THE  THROAT  AND  AIR-PASSAGES.  151 


CHAPTER   XIII. 

DISEASES  OF  THE  THEOAT  AND  AIK-PASSAGES. 

Croup  and  Diphtheria — Simple  Spasmodic  Croup,  what  its  Symp- 
toms are  and  how  to  treat  it — Membranous  Croup,  its  Symp- 
toms and  Treatment — The  Difference  between  Membranous 
Croup  and  Diphtheria — Diphtheria  as  a  Cause  of  Membran- 
ous Croup — The  Nursing,  and  the  Use  of  Household  Eemedies 
in  their  Treatment. 

The  diseases  which  probably  cause  the  most  alarm 
among  mothers,  and  justly  so,  are  those  which  affect  the 
throat ;  especially  when  there  is  the  slightest  possibility 
of  the  disorder  being  either  diphtheria,  or  membranous 
croup.  I  propose  to  give  in  as  simple  language  as  pos- 
sible, so  that  it  can  be  readily  understood,  a  description 
of  these  various  acute  diseases  of  the  throat  in  children, 
not  for  the  purpose  of  enabling  the  mother  or  nurse  to 
make  a  diagnosis, — that  is  not  her  business, — but  simply 
to  enable  her  to  carry  out  thoroughly,  conscientiously, 
and  intelligently  the  nursing,  which  forms  so  important 
a  part  in  the  treatment  of  these  diseases.  Undoubtedly, 
in  times  gone  by,  children  suffered  very  much  more 
from  croup  than  they  do  at  present.  The  change  in 
this  respect  has  been  brought  about  by  the  doing  away 
with  the  short-sleeved  and  low-necked  dresses  of  chil- 
dren, and  the  thorough  understanding  of  the  fact  that 
in  a  climate  as  changeable  as  ours  the  whole  surface  of 
the  body,  from  the  neck  to  the  feet,  should  be  protected 
from  the  sudden  chilling  of  the  surface  by  wearing  a 
garment,  be  it  ever  so  thin,  of  either  wool,  or  wool  and 
silk  mixed. 

We  hear  a  great  deal  of  diphtheria,  and  it  is  well  for 
us  to  understand  what  is  meant  by  this  term.  The 
word  has  been  applied  to  a  disease  which  is  characterized 


152  CHILDHOOD. 

by  a  deposit  upon  the  throat,  and;  consequently,  every 
time  a  deposit  is  noticed  upon  a  child's  throat  it  is  at 
once  thought  to  have  diphtheria.  This  is  a  mistake ; 
what  really  constitutes  this  dreaded  disease  is  a  profound 
constitutional  poisoning,  caused  by  exposure  to  sewer- 
air,  polluted  water  or  milk,  exposure  from  contagion  of 
the  same  disease,  by  which  the  system  is  profoundly 
poisoned  with  the  local  trouble,  manifesting  itself  in  the 
throat,  larynx,  or  air-passages.  A  child  may  have  diph- 
theria without  any  appearance  of  membrane  in  its 
throat ;  then  again  deposits  may  be  found  on  the  tonsils, 
as  in  quinsy,  which  is  not  diphtheria  at  all ;  but  for  the 
sake  of  caution,  children  affected  with  sore  throats 
should  be  isolated  until  seen  by  the  doctor.  Those  who 
are  well  should  not  use  the  same  spoon  or  drinking-cup 
as  those  that  are  ailing  ;  this  applies  to  adults  as  well 
as  to  children. 

There  are  mild  forms  of  diphtheria,  affecting  adults, 
during  which  the  constitution  is  not  sufficiently  affected 
to  prevent  their  going  about  their  daily  avocations,  and 
such  individuals  are  beyond  a  doubt  the  means  of  carry- 
ing contagion  to  those  with  whom  their  breath  comes  in 
contact.  There  is  no  doubt  but  that  many  times  diph- 
theria, and  other  diseases  even  worse,  have  been  carried 
to  children  by  the  foolish  and  useless  practice  of  kissing 
to  which  the  poor  little  ones  are  subjected.  It  seems 
strange  that  a  child  who  will  be  protected  most  ener- 
getically from  draughts,  from  every  form  of  open  con- 
tamination, will  be  permitted  to  come  in  direct  contact 
— the  most  thorough  means  of  propagating  contagion 
— with  diphtheria,  whooping-cough,  scarlet  fever,  and 
worse,  by  kissing.  I  dwell  upon  this,  because  I  feel 
that  parents  should  instruct  their  nurses  to  prevent 
their  children  being  kissed  by  other  children  and  by 
strangers. 

A  sore  throat  should  always  be  looked  upon  with 
suspicion  in  a  child,  and  carefully  treated;  and  espe- 


DISEASES  OF  THE  THROAT  AND  AIR-PASSAGES.  153 

cially  if  the  child's  neck  is  swollen  on  the  outside,  the 
glands  enlarged,  should  there  be  a  coated  tongue,  offen- 
sive breath,  and  great  prostration.  No  one  should  at- 
tempt to  treat  a  case  of  this  kind  without  immediately 
consulting  the  doctor;  it  is  a  recognized  fact  that 
should  by  chance  the  little  patient  have  been  exposed 
to  sewer-air  from  a  defective  stationary  washstand  in 
the  bedroom,  or  from  the  bath-room  or  closet,  a  simple 
catarrh  of  the  throat  from  cold  will  allow  the  diph- 
theritic germ,  or  whatever  the  poison  may  be,  to  be 
engrafted  upon  it  or  be  absorbed  into  the  system,  and 
the  only  means  of  counteracting  its  influence  would  be 
the  most  active  cauterization  of  the  throat,  and  placing 
the  child  upon  stimulants  and  medications  that  will 
strengthen  it. 

Whenever  a  child  complains  of  a  sore  throat  and 
there  seems  to  be  redness  of  the  throat  inside,  or  the 
tonsils  become  swollen  and  the  child  complains  of 
swallowing,  has  a  cough,  it  is  always  safe  and  indeed  a 
proper  thing  to  spray  the  throat  and  nose  with  some 
mild  solution  that  will  at  once  cleanse  and  soothe 
it.  This  will  never  interfere  with  the  doctor's  treat- 
ment, and  can  be  done  before  the  doctor  comes.  The 
best  forms  of  atomizers  that  I  know  of,  and  one  of 
which  should  be  in  every  household,  are  the  David- 
son's small  hand  atomizer,  which  is  valuable  for  spray- 
ing the  throat  and  nose,  and  that  of  Oliver,  a  more  ex- 
pensive one,  but  the  very  best  so  far  made  for  inhaling 
lime-water  or  such  substances  as  are  used  in  cases  of 
croup.  A  solution  known  as  Dobell's  solution  can  be 
used  in  these  cases;  also  in  cases  of  whooping-cough, 
or  in  all  forms  of  sore  throat. 

There  are  many  diseases  of  children  that  are  accom- 
panied by  sore  throat  or  sore  mouth,  that  require  con- 
stant cleansing  of  the  mucous  membrane,  or  the  deposit, 
or  mucus,  will  accumulate,  become  offensive,  or  finally, 
as  in  diphtheria,  become  putrid.     Great  care  should  be 


154  CHILDHOOD. 

paid  to  the  slightest  throat-ailments  of  children,  because 
an  irritated  throat  is  often  an  opening  for  the  entrance 
of  infectious  disease. 

A  child  complaining  of  difficulty  of  swallowing 
should  under  no  circumstances  be  allowed  to  go  out 
of  doors,  especially  if  the  weather  is  damp  or  at  all 
raw  or  cold.  The  throat  should  be  gently  sprayed 
with  the  solution  just  mentioned,  and  some  counter- 
irritation  made  to  the  outside,  using  St.  John  Long 
Liniment,  or  simple  rubbing  with  vaseline,  sweet  oil, 
or  cod-liver  oil.  If  the  child's  voice  is  slightly  muffled 
in  speaking,  if  it  speaks  through  its  nose,  should  there  be 
tenderness  upon  pressure  and  slight  enlargement  of  the 
gland  under  the  angle  of  the  jaw,  on  one  side,  and  the 
attack  come  on  suddenly,  in  an  older  child  with  a  chill 
or  high  fever,  the  probability  is  the  attack  is  one  affect- 
ing the  tonsils, — one  of  quinsy.  The  household  rem- 
edies to  be  used  in  such  a  case  would  be  a  fever-drink 
of  one  teaspoonful  of  spirits  of  Mindererus  (liquor  am- 
monise  acetatis),  one  teaspoonful  of  sweet  spirits  of  nitre 
to  half  a  glass  of  water,  sipped  at  frequent  intervals,  for 
a  child  about  five  years  of  age.  The  feet  should  be  put 
in  a  hot  mustard-bath  and  the  stockings  kept  on  after- 
wards, the  throat  sprayed,  the  child  allowed  small 
pieces  of  cracked  ice ;  the  food  for  at  least  twenty- 
four  hours  should  consist  of  beef-tea  or  chicken-broth, 
or  probably  still  better,  if  the  child  will  take  it,  milk 
and  lime-water,  or  Vichy  water,  half  and  half.  In 
all  these  acute  throat-troubles  of  children  I  have  found 
the  early  application  of  a  handkerchief  wrung  out  of 
cool  water,  tied  round  the  throat  like  a  cravat  and  cov- 
ered by  oiled  silk,  of  very  great  service  in  sore  throats 
that  come  from  exposure  to  dampness,  getting  the  feet 
wet,  or  where  the  voice  is  husky  with  a  slight  cough, 
which  has  a  tendency  to  become  dry  or  ringing,  espe- 
cially towards  night.  This  treatment  will  often  avert 
an  attack  of  croup.     Throat-troubles  in  children  are  by 


DISEASES  OF  THE  THROAT  AND  AIR-PASSAGES.  155 

far  too  serious  to  allow  of  any  time  to  elapse  before  re- 
ceiving the  most  thorough  treatment :  when  a  child 
complains,  it  is  far  better  to  send  at  once  for  the 
doctor. 

CEOUP. 

There  are  some  children  who  are  particularly  liable 
to  croup  :  it  seems  a  family  characteristic.  Boys  are 
more  apt  to  have  it  than  girls, — possibly  because  they 
are  more  exposed ;  indeed,  the  tendency  to  "harden"  chil- 
dren by  letting  them  go  bare-legged,  or  with  low  necks 
and  short  sleeves,  will  sooner  or  later  bring  either  a  bad 
attack  of  croup,  or  bronchitis,  as  a  consequence.  Children 
who  go  permanently,  as  do  many  of  the  poor,  without 
shoes  or  stockings,  are  not  as  apt  to  contract  these 
catarrhal  diseases  as  those  who  temporarily  have  their 
feet  exposed  to  cold,  sudden  changes,  or  dampness ;  but 
the  child  who  is  over-dressed  will  perspire  and  be  as  liable 
to  attacks  of  croup  or  bronchitis  as  one  who  is  insuffi- 
ciently dressed.  What  is  ordinarily  known  as  croup  is 
that  affection  which  comes  on  suddenly  at  night,  accom- 
panied by  a  dry,  ringing  cough,  difficulty  in  breath- 
ing, all  evidences  of  threatened  suffocation,  without  any 
marked  previous  symptom.  It  usually  occurs  at  night. 
The  child  will  wake  from  sleep  with  all  the  symptoms 
that  are  most  terrifying.  Its  evident  spasmodic  character 
has  given  it  the  name  of  spasmodic  croup.  It  may  be 
the  result  of  cold  or  of  an  overloaded  stomach,  and 
children  who  are  subject  to  this  affection  should  not  be 
allowed  heavy  suppers. 

Although  the  breathing  is  greatly  interfered  with 
during  this  attack,  the  sounds  are  ringing,  the  cough 
sonorous  and  brassy  and  loud  ;  this  is  an  important 
matter,  as  it  shows  there  is  no  deposit  of  membrane  to 
muffle  the  sound.  The  treatment  of  such  a  case  should 
be  as  follows  :  a  sponge  wrung  out  in  water  as  hot  as  can 
be  borne  by  the  child  should  at  once  be  tied  round  the 


156  CHILDHOOD. 

throat,  and  kept  there  by  a  towel,  or  better,  oiled  silk  ; 
the  feet  and  legs  as  far  as  the  knees  should  be  immersed 
in  a  hot  bath  containing  a  few  tablespoonfuls  of  mustard 
flour,  and  be  kept  in  the  water  for  at  least  fifteen  minutes, 
then  thoroughly  dried,  and  a  pair  of  stockings  put  on. 
The  child  should  be  given  a  half-teaspoonful  or  a  whole 
teaspoonful  of  syrup  of  ipecac, — the  latter  if  the  child 
is  over  four  years  of  age, — followed  by  a  drink  of  water 
every  fifteen  minutes  until  it  vomits ;  after  which  the 
spasms  will  cease,  and  the  child  will  turn  over  from  ex- 
haustion, and  sleep  the  remainder  of  the  night.  A  pow- 
der of  half  sugar  and  half  alum,  given  in  teaspoonful 
doses  or  given  with  the  ipecac,  will  hasten  its  emetic 
action.  If  the  child  is  anxious  and  restless  after  the 
attack  of  croup  has  subsided,  sleep  seems  impossible,  or 
some  cough  still  remains, — for  a  child  from  a  year  and 
a  half  to  two  years  old,  ten  drops  of  paregoric  in  a  tea- 
spoonful of  glycerin,  repeated  in  an  hour,  will  have  a 
quieting  effect,  or  ten  drops  of  sweet  spirits  of  nitre, 
given  in  a  little  sugar  and  water,  can  be  given  every 
half-hour  or  hour  until  the  child  is  quiet.  If  the 
bowels  have  not  been  moved  during  the  day,  or  are 
constipated,  an  injection  of  warm  suds  will  frequently 
bring  relief. 

Possibly  after  a  good  sleep  the  next  day  the  child  will 
be  in  ordinary  good  health  without  any  marked  evidence 
of  exhaustion  from  the  attack  of  the  previous  night ; 
or  it  may  be  slightly  droopy,  have  an  occasional  cough 
which  is  rather  ringing ;  the  appetite  may  be  impaired. 
If  such  is  the  case,  it  would  be  well  to  give  the  child  a 
dose  of  castor  oil,  and  by  all  means  keep  it  in  the  nur- 
sery. If  the  child  is  over  a  year  old,  give  it  from  five  to 
ten,  or  if  the  child  is  three  years  old,  fifteen,  drops  of  the 
aromatic  spirits  of  ammonia,  every  three  hours.  If  chil- 
dren who  have  a  tendency  to  hoarseness  and  croup  have 
their  feet  washed  in  a  basin  of  cool  water  every  night  be- 
fore retiring,  they  will  often  escape  an  attack.   It  should 


DISEASES  OF  THE  THROAT  AND  AIR-PASSAGES.  157 

also  be  borne  in  mind  that  it  is  not  essential  that  a  child 
should  have  a  bath  every  day,  as  some  mothers  believe ; 
if  the  weather  is  damp  or  raw,  the  child  at  all  droopy, 
the  surface  can  be  very  quickly  sponged,  simply  for 
cleansing,  and  with  salt  water,  and  the  circulation  in- 
creased by  a  thorough  rubbing  with  a  soft  towel.  I 
think  if  the  rule,  which  seems  to  be  a  cast-iron  one 
with  many  mothers,  of  bathing  children  every  day 
and  taking  them  out  in  all  kinds  of  weather,  could  be 
occasionally  broken,  we  would  not  have  so  many  sick 
children. 

MEMBRANOUS   AND   DIPHTHERITIC   CROUP. 

There  is  nothing  more  appalling,  or  none  that  seems 
more  strenuously  to  resist  all  efforts  at  successful  med- 
ical treatment,  than  that  form  of  croup  which  is  accom- 
panied by  the  presence  of  thick  mucus  in  the  air- 
passages  of  the  larynx,  or  diphtheritic  membrane. 
When  speaking  of  diphtheria  I  dwelt  upon  the  fact 
that  it  was  a  constitutional  blood-poisoning,  which  could 
exist  without  the  presence  of  membrane  in  the  throat, 
and  also  that  the  membrane,  when  it  did  exist,  need  not 
be  limited  to  the  portions  of  the  throat  that  we  can  see, 
but  could  extend  to  the  whole  surface  of  the  mucous 
membrane  down  to  the  lungs,  and  upward  into  the  nose ; 
indeed,  when  it  does  so,  it  clings  firmly  to  the  mucous 
membrane,  leaves  a  raw  surface  when  detached,  and  if 
allowed  to  remain  acts  as  an  obstruction  to  the  entrance 
of  air,  or  decomposes,  becomes  'putrid,  and  in  this  way 
acts  still  further  as  a  poison.  It  is  on  this  account  that 
the  spraying  of  the  throat  with  an  alkaline,  antiseptic 
solution,  which  softens  the  membrane  and  prevents  its 
decomposition,  has  been  recommended  in  the  most 
trivial  throat-complaints  as  a  precautionary  measure. 

Membranous  croup  is  recognized  to  be  of  two  varie- 
ties,— one  the  result  of  catarrh,  when  the  obstruction  is 
caused  by  very  thick  mucus  in  the  larynx  which  may 

14 


158  CHILDHOOD. 

become  tenacious  like  membrane,  and  the  other  due  to 
the  deposit  of  diphtheritic  membrane,  which  may  be 
found  in  connection  with  the  appearance  of  deposit  in 
the  other  parts  of  the  throat,  or  may  be  simply  lim- 
ited to  the  air-passages.  A  child  with  membranous 
croup  will  probably  be  ailing  for  a  few  days ;  its  cough 
will  at  first  be  croupy,  its  voice  will  become  husky, 
the  cough  will  cease,  or  nearly  so ;  the  breathing  will 
become  labored,  and  finally  will  be  plainly  heard  at  a 
distance ;  the  child  will  show  by  its  movements  that 
there  is  narrowing  of  the  passage  in  its  larynx ;  the 
nostrils  will  dilate  with  each  inspiration  ;  the  child 
will  breathe  with  its  mouth  open,  it  will  desire  to  sit 
up,  so  as  to  get  all  the  air  possible ;  the  lips  will  be- 
come blue,  owing  to  the  interference  with  the  circula- 
tion ;  the  child  will  become  anxious,  restless,  appealing 
to  every  one  around  it  for  relief;  it  will  refuse  food,  but 
will  drink  water  in  sips  at  a  time.  If  the  obstruction 
continues  or  increases,  the  extremities  become  cold,  the 
pulse  rapid  and  at  times  irregular ;  and  finally,  if  noth- 
ing is  done  for  the  relief  of  the  child,  it  will  gradually 
die  of  asphyxia,  or  a  sudden  shutting-off  of  the  supply 
of  air. 

A  peculiarity  of  the  breathing  in  obstruction  of  the 
larynx  is  the  contraction,  or  sinking  in,  of  the  lower 
portions  of  the  ribs,  or  pit  of  the  stomach  or  epigas- 
trium (in  health  these  parts  expand),  and  the  marked 
depression,  or  sucking  in,  of  the  lower  portion  of  the 
neck,  just  above  the  breast-bone.  But  probably  eight 
cases  out  of  ten  of  membranous  croup  with  which  one 
comes  in  contact  are  due  to  a  diphtheritic  blood-poison- 
ing, which  we  may  attribute,  in  our  larger  cities,  to 
defective  stationary  washstands  in  the  sleeping  apart- 
ment or  nursery,  absolutely  conveying  the  most  poi- 
sonous form  of  sewer-air  from  a  bad  cesspool  or  drain 
directly  to  the  infant's  room.  One  should  never  rest 
assured  that  the  trap  of  the  bath-tub,  or  its  overflow,  is 


DISEASES  OF  THE  THROAT  AND  AIR-PASSAGES.  159 

secure,  or  that  of  the  stationary  washstand  in  the  child's 
nursery  or  sleeping  apartment ;  these  should  be  ban- 
ished to  an  adjoining  room,  where  they  have  free  com- 
munication with  the  fresh  air,  and  should  be  well  sup- 
plied by  some  form  of  disinfectant,  as  that  used  by  the 
Germicide  Company.  But  then  again  a  child  with  a 
slight  sore  throat  may  be  exposed  to  the  gases  coming 
from  an  open  sewer;  or  through  the  air  supplied  to  a 
furnace,  which  is  passed  over  putrefying  matter,  or 
stagnant  water  in  the  cellar ;  to  the  breath  of  one  con- 
valescent from  the  disease,  or  who  has  it  in  a  mild 
form,  communicated  by  kissing.  In  addition  to  this, 
milk  when  mixed  with  water  which  has  been  contam- 
inated by  sewerage,  has  been  known  to  produce  this 
disease ;  it  is  on  this  account  that  the  catarrhs,  especially 
of  the  croupy  kind,  however  slight,  should  be  attended 
to  at  once  in  children,  as  they  constitute  a  point  of 
entrance  of  the  diphtheritic  poison  into  the  system ;  and 
as  children  over  a  year  old  are  very  much  more  subjected 
to  the  sudden  changes  that  produce  these  catarrhs,  all 
forms  of  membranous  croup  are  more  apt  to  take  place 
at  that  time. 

Let  us  dwell  for  a  few  moments  upon  the  nursing  of 
such  cases.  There  are  two  facts  most  important  to  bear 
in  mind  as  causes  of  death :  the  one,  the  interference 
with  the  entrance  of  air  into  the  larynx  or  air-passages  ; 
the  other,  the  poisoning  of  the  system,  and  the  weaken- 
ing of  the  heart,  which  accompanies  diphtheria,  and 
makes  the  patient  more  readily  succumb  to  the  influences 
of  deficient  aeration. 

If  a  child  has  a  croupy  cough  during  the  day,  rapidity 
of  breathing,  slight  fever,  no  time  should  be  lost  to 
influence  at  once  the  mucous  membrane,  to  establish 
secretion  and  give  relief.  The  child  should  be  kept  in 
its  nursery,  and  I  may  say  that  in  all  cases  of  bron- 
chitis or  pneumonia,  and  even  croup  when  a  child 
has  to  be  lifted  constantly  from  its  bed,  or  cannot  be 


160  CHILDHOOD. 

comfortable  for  any  length  of  time  in  one  position,  it 
should  have  a  long  flannel  wrapper  extending  much 
below  its  feet,  that  can  be  opened  in  front  and  at  the 
back,  with  high  neck  and  long  sleeves.  It  is  absolutely 
necessary  that  the  air  of  the  nursery  be  not  only  pure 
but  warm,  the  temperature  about  80°.  The  air  should 
be  moist,  and  for  this  purpose  some  arrangement  must 
be  made  to  have  a  constant  supply  of  steam ;  this  can 
be  done  by  placing  a  kettle  on  the  stove  if  there  is  one 
in  the  room,  or  by  using  a  tea-kettle  with  a  lamp  under 
it  for  that  purpose.  If  the  case  seems  to  be  one  of 
more  than  an  ordinary  slight  cold,  no  time  should  be 
lost  in  allowing  the  vapor  of  an  alkali  to  come  in  con- 
tact with  the  mucous  membrane,  and  there  is  none 
better  for  this  purpose  than  that  which  comes  from 
slaked  lime.  Lime  can  be  placed  in  a  bucket  beneath 
or  beside  the  child's  crib,  and  the  crib  covered  over 
with  a  sheet  in  the  form  of  a  tent,  allowing  the  vapor 
to  accumulate  within ;  if  the  child  is  only  satisfied  to 
remain  on  the  mother's  lap,  the  vapor  can  readily  be 
brought  in  contact  by  a  sheet  thrown  over  the  bucket, 
and  extending  over  her  own  shoulder.  The  advantages 
of  the  vapor  from  lime  are  its  moisture,  its  warmth,  its 
alkalinity ;  and  if  membrane  should  form  in  the  throat 
lime-vapor  honeycombs  it,  the  same  as  lime-water  does 
the  curd  of  milk.  If  the  child  seems  to  suffer  very 
much  from  the  obstruction,  that  is  to  say  the  breathing 
becomes  rasping,  the  spray  from  an  atomizer — and  a 
steam  one  is  much  to  be  preferred — should  be  used 
constantly ;  or  if  the  child  is  old  enough  it  can  prob- 
ably for  several  minutes  at  a  time  inhale  the  vapor 
from  the  Oliver  vaporizer.  The  solution  to  be  em- 
ployed in  these  cases  is  one-half  lime-water  and  one- 
half  Dobell's  solution,  or  if  two  vaporizers  are  in  use, 
as  should  be  the  case,  so  as  constantly  to  have  some 
form  of  steam  inhaled,  one  solution  should  be  of  turbid 
lime-water,  made  by  adding  a  teaspoonful  of  liquor 


DISEASES  OF  TEE  THROAT  AND  AIR-PASSAGES.  161 

jjotassce  to  two  ounces  of  lime-water.  These  cases  are 
so  important  as  regards  the  very  early  treatment  that  I 
do  not  hesitate  to  suggest  that  the  mother  or  nurse,  if 
she  cannot  get  the  advice  of  a  physician  at  once,  should 
lose  no  time,  but  place  the  child  upon  a  treatment  as 
follows,  until  the  doctor  arrives. 

If  the  child's  croupy  cough  or  hoarseness  should  con- 
tinue during  the  daytime  even  after  the  hot  foot-bath 
and  the  warm  applications  to  the  throat  (flannel  wrung 
out  in  hot  vinegar  and  water,  and  covered  by  oiled 
silk),  the  following  fever  mixture,  which  will  possibly 
also  loosen  the  cough,  should  be  given  until  the  doctor's 
arrival : 

Solution  of  Acetate  of  Ammonium,  one  ounce  and  a  half; 
Solution  of  Citrate  of  Potassium,  one  ounce ; 
Compound  Syrup  of  Squill,  one  drachm ; 
Simple  Elixir,  sufficient  to  make  three  ounces. 

Dessertspoonful  in  water  every  two  hours,  for  a  child 
of  two  years. 

The  question  of  an  emetic  may  be  a  serious  one  if 
suffocation  seems  imminent.  If  the  child  struggles  for 
breath,  or  its  face  becomes  bluish,  its  extremities  be- 
come cold,  and  the  other  signs  of  which  I  have  spoken 
exhibit  themselves,  a  half-teaspoonful  of  alum,  with 
the  same  quantity  of  powdered  sugar,  or  given  with 
water,  would  form  the  safest  emetic.  A  harsh  emetic 
such  as  ipecac  may  disorder  the  stomach  without  a 
correspondingly  good  effect,  indeed  may  increase  the 
debility,  and  should  not  be  given  without  the  doctor's 
advice.  In  addition  to  this,  at  least  every  hour  a  child 
of  over  a  year  should  take  five  drops  of  the  aromatic 
spirits  of  ammonia,  in  water. 

Warmth  and  moisture  should  be  applied  to  the  chest 
and  throat.  Some  physicians  recommend  the  use  of 
some  material  that  will  readily  absorb  large  quantities 
I  14* 


162  CHILDHOOD. 

of  liquid ;  a  mass  of  lint  or  folds  of  flannel  or  some 
patent  material  may  be  connected  by  shoulder-straps 
and  tapes  at  the  side,  soaked  in  warm  water  (wrung  out 
to  prevent  its  dripping),  placed  on  the  front  and  back, 
and  covered  with  oiled  silk,  and  changed  about  twice  a 
day  or  oftener.  Care  should  be  taken  when  the  change 
is  made ;  it  should  be  done  by  placing  the  hand  beneath 
the  wrapper,  and  without  exposing  the  child's  chest  at 
all.  Others  prefer  ordinary  flaxseed  poultices,  made  in 
the  same  way.  My  own  preference  is  for  two  flannel 
bags  filled  with  hops  and  quilted ;  these  can  readily  be 
attached  by  safety-pins  on  the  outside,  and  thus  kept 
in  place ;  oiled  silk  can  be  stitched  on  to  each  one,  so 
as  to  prevent  evaporation,  and  these  bags  can  either  be 
wrung  out  in  water,  or  some  soothing  or  stimulating 
liniment,  as  the  occasion  requires. 

The  child's  diet  must  be  carefully  attended  to.  It 
should  be  encouraged  to  drink  freely  of  milk,  and  lime- 
or  Vichy  water,  chicken-broth  or  beef-tea,  or,  if  it  prefers 
it,  small  quantities  of  beef-juice,  or  beef  extract  or 
peptonoids.  Wine-whey,  in  cases  where  there  seems  to 
be  debility,  is  absolutely  essential,  or  ten  to  fifteen  drops 
of  port  wine,  whiskey,  or  brandy,  in  water,  or  a  tea- 
spoonful  of  malt  extract  should  be  given  every  three 
or  four  hours. 

In  regard  to  the  feeding  of  sick  children,  absolute 
regularity  and  accuracy  must  be  observed  in  their  diet. 
The  food  should  be  of  the  most  nourishing  character, 
requiring  least  digestion,  and  in  as  small  bulk  as  pos- 
sible. There  should  be  a  schedule  kept  of  the  exact 
amount,  and  time  it  is  given,  so  that  the  doctor  may 
judge  of  the  fact  as  to  whether  the  child  needs  more 
or  less  in  the  twenty-four  hours.  In  some  diseases, 
such  as-  diphtheria  and  typhoid  fever,  the  child's  life 
depends  on  this  systematic  nourishment.  In  the 
latter,  the  dietetics  form  the  most  important  consider- 
ation, because  for  a  long  period,  at  least  three  weeks, 


DISEASES  OF  THE  THROAT  AND  AIR-PASSAGES.  163 

the  child's  life  is  to  be  sustained  by  a  diet  so  regulated 
that  it  will  give  all  possible  nourishment,  and  at  the 
same  time  not  unduly  stimulate  the  moving  of  the 
bowel,  or  act  as  an  irritant  to  those  portions  which  are 
already  inflamed  or  ulcerated.  In  the  nursing  of  diph- 
theria, the  most  important  points  to  bear  in  mind  are, 
first  of  all,  that  it  is  a  disease  capable  of  being  greatly 
modified  by  careful  treatment  and  nursing ;  that  it  is 
directly  contagious  by  means  of  contact  with  the  mem- 
brane ;  that  systematic  nourishment  and  stimulation 
are  absolutely  essential. 

Indeed,  all  continued  croupy  coughs  should  be  looked 
upon  as  serious,  even  should  no  evidences  of  diphtheria 
be  detected  in  the  throat.  Recently  the  great  facility  of 
placing  a  tube  through  the  mouth  into  the  larynx  has 
been  demonstrated,  with  the  result  of  a  great  saving  of 
life.  It  is  an  operation  devoid  of  the  horrors  of  opening 
the  trachea,  and  can  be  made  use  of  very  early  in  the 
case,  before  the  child  is  exhausted  and  the  air-passages 
are  filled  with  membrane  or  thick  mucus. 

Whether  due  to  diphtheria  or  not,  the  treatment  and 
nursing  of  membranous  croup  are  practically  the  same. 
A  child  suffering  from  this  disease  should  have  its 
throat  washed  and  sprayed  with  antiseptic  cleansing 
solutions  frequently,  in  order  to  prevent  decomposition 
of  the  membrane ;  the  air  that  it  breathes  should  be 
pure,  and  at  the  same  time  charged  with  those  materi- 
als that  soften  the  deposit  of  the  membrane  and  prevent 
its  putridity.  For  this  we  have  the  vapor  of  steam 
containing  lime,  the  products  of  tar  or  carbolic  acid, 
and  chlorine ;  but  as  I  have  gone  over  this  matter 
thoroughly  when  writing  of  scarlet  fever,  it  will  not 
be  necessary  to  repeat  it  here. 


164  CHILDHOOD. 


CHAPTER  XIV. 

DIAKKHCEA. 

The  Causes  of  Diarrhoea — Over-feeding ;  Tainted  Milk ;  Decompo- 
sition of  Food ;  Undigested  Starches  ;  Teething ;  Hot  "Weather 
— Inflammatory  Diai'rhcea — How  it  can  be  avoided — Change  of 
Diet  necessary,  also  Absolute  Quiet,  Pure  Drinking-Water,  and 
Fresh  Air— The  Character  of  the  Diet — Importance  of  Pepton- 
ized Milk  and  Nutritious  Injections. 

This  is  one  of  the  most  important  subjects  for  our 
consideration.  We  have  it  varying  from  simple  fre- 
quency in  the  natural  movement,  to  that  most  violent 
form  which  occurs  in  summer-time;  but  as  the  one  leads 
to  the  other,  mothers  should  be  instructed  how  to  treat 
the  earliest  symptoms,  so  as  to  check  them  before  there 
is  any  necessity  for  medical  treatment. 

Indigestion  is  the  one  great  common  cause,  and,  as  we 
have  before  noticed,  indigestion  is  produced  by  improper 
food,  over-feeding,  or  those  depressing  conditions  which 
surround  the  child  and  prevent  the  digestion  of  its  food, 
allowing  it  to  ferment  and  act  as  an  irritant.    All  these 

O  •  •  • 

causes  can  act  equally  well  m  winter  as  in  summer,  at  the 
sea-shore  or  mountains  as  in  the  crowded  cities  with  un- 
healthy surroundings,  in  older  children  as  well  as  in 
infants ;  but  as  a  rule  they  are  very  much  more  active 
in  the  overheated  atmosphere  of  our  densely-populated 
city  during  the  summer,  and  infants  that  are  obliged  to 
stay  in  town  are  much  more  depressed,  have  less  vitality, 
and  their  food  is  more  apt  to  be  tainted  by  the  germs 
of  putrefaction. 

Over-feeding  is  so  constantly  a  cause  of  diarrhoea 
that  it  deserves  a  few  words  of  caution.  Many  young 
mothers  believe  that  if  an  infant  cries  it  is  always  an 


DIARRHCEA.  165 

evidence  of  hunger ;  this  is  by  no  means  the  case ;  it 
may  be  simply  thirsty.  If  it  is  nursed  at  its  proper 
time  and  has  received  its  usual  amount,  a  few  spoonfuls 
of  water  will  often  quiet  it  instead  of  having  recourse 
to  the  breast  or  bottle.  I  cannot  lay  too  much  stress  on 
the  importance  of  water;  especially  in  the  summer-time ; 
when  given  judiciously  and  frequently  it  may  often  save 
the  child  an  attack  of  summer-complaint.  Give  cool 
water ;  do  not  give  iced  water,  but  let  it  be  pure, 
filtered  always,  and  if  there  is  the  least  suspicion  of 
its  purity  have  it  boiled.  Do  not  put  sugar  in  it. 
Mothers  should  watch  carefully  the  urine  of  their  chil- 
dren ;  if  the  child  cries  suddenly,  in  a  rather  shrill  cry 
which  is  characteristic,  it  has  probably  wet  itself  and 
should  be  immediately  changed,  the  parts  thoroughly 
dried  and  slightly  greased  to  prevent  irritation.  If  there 
should  be  a  reddish  deposit  on  the  diaper,  this  is  an 
evidence  of  indigestion  or  want  of  water  to  dissolve 
these  crystals  of  uric  acid.  In  such  cases  the  urine  is 
usually  scanty.  It  will  be  found  that  a  teaspoonful 
of  soda-mint  solution  in  a  small  teacup  of  water,  or 
lithia-water,  which  the  child  should  drink  as  freely  as 
it  will  or  take  it  from  a  spoon,  will  soon,  if  kept  up 
for  two  or  three  days,  correct  this  condition. 

The  child  will  cry  if  its  position  becomes  irksome. 
It  requires  to  be  turned  over  in  bed  if  it  feels  the  cold, 
and  requires  the  warmth  of  the  nurse's  arms  to  lull  it  to 
sleep,  if  its  clothing  irritates  it,  if  the  bands  of  its 
clothes  are  too  tight,  owing  to  flatulence  extending  the 
abdomen.  Frequently  it  will  cry  from  irritation  of  the 
skin,  due  from  what  is  known  as  prickly  heat.  A  little 
vaseline  rubbed  on  will  soothe  it ;  or  if  the  cry  be 
sudden  and  sharp,  it  will  be  noted  to  be  one  of  pain. 
Frequently  this  will  be  caused  by  the  passage  of  its 
water,  and  the  doctor's  attention  should  be  called  to  the 
parts.  All  these  matters  should  be  always  taken  into 
consideration  and  careful lv  investigated  before  the  child 


166  CHILDHOOD. 

should  receive  more  food  than  its  regular  nursing  every 
two  or  three  hours. 

Over-feeding  is  generally  recognized  by  the  evidences 
of  the  insufficient  digestion  in  the  passages,  or  by  the  fre- 
quency of  the  movements,  although  they  may  not  devi- 
ate from  the  normal  condition  ;  or  the  stomach  may 
become  overloaded,  and  the  uneasiness  of  the  child 
following  its  taking  of  food,  its  restlessness  during 
sleep,  possibly  nausea  or  vomiting,  will  be  the  conse- 
quence. It  is  a  fortunate  thing  that  a  child  vomits 
very  readily,  and  therefore  food  that  disagrees  with  it, 
fermenting  in  its  stomach,  can  be  gotten  rid  of  without 
passing  through  the  intestines,  which  are  so  easily  irri- 
tated by  such  matters.  If  these  symptoms  just  noted 
be  present,  the  child's  breath  heavy  or  sour,  and  espe- 
cially if  it  is  a  bottle-fed  baby,  it  will  be  well  for  the 
mother  to  encourage  vomiting.  The  simplest  means 
of  so  doing  is  to  give  the  child  a  glass  of  water  and 
follow  this  by  giving  a  half-teaspoonful  of  syrup  of 
ipecac  every  fifteen  minutes  until  vomiting  is  pro- 
duced. 

The  next  cause  of  diarrhoea  for  us  to  study  is  that 
produced  by  the  food.  It  is  a  well-known  fact  that 
the  nursing  mother,  living  on  certain  articles  of  diet, 
can  so  alter  her  milk  as  to  make  it  a  potent  cause  of 
indigestion.  It  is  also  known  that  emotions,  pas- 
sion, fright,  will  so  alter  the  character  of  the  milk  as 
to  produce  the  same  effect.  Also  any  irritation  of 
the  nipple  producing  in  the  child  a  sore  mouth  will  be 
the  starting-point  of  a  catarrh  of  the  stomach  and  bowel ; 
this  can  be  readily  obviated  by  cleanliness,  the  use 
of  borax,  glycerin,  and  rose-water  as  a  wash,  and  vase- 
line to  the  nipple  to  prevent  cracking.  I  have  frequently 
observed  the  fact  that  a  mother  can  depart  from  this 
rule  of  careful  dieting  on  many  occasions  without  alter- 
ing her  milk,  in  a  way  that  would  affect  her  own  child, 
whereas  the  same  milk  given  to  another  child,  should 


DIARRHCEA.  167 

she  act  as  a  wet-nurse,  would  be  followed  by  harmful 
results.  The  close  sympathy  between  mother  and  child 
is  thus  kept  up  after  its  birth.  All  physicians  have 
known  of  cases  of  infants  at  the  breast  that  have 
suffered  from  violent  attacks  of  diarrhoea,  convulsions, 
the  result  of  violent  emotion,  fright,  or  passion  on  the 
part  of  the  wet-nurse.  It  is  this,  together  with  the 
high  living  to  which  they  are  unaccustomed,  the  seden- 
tary occupation  which  encourages  biliousness,  carelessness 
in  diet,  the  inability  to  watch  them  in  every  particular 
as  to  their  functional  health,  morals,  personal  clean- 
liness, that  renders  wet-nursing  so  unreliable. 

Certain  substances  have  a  peculiar  tendency  towards 
the  milk.  Castor  oil  taken  by  the  nursing  woman  will 
purge  the  child ;  mercurials  will  sometimes  have  the 
same  effect ;  onions,  garlic,  will  be  noticeable  in  the 
milk  and  cause  indigestion.  Alcohol  will  find  its  way 
to  the  milk ;  this  fact  has  been  taken  advantage  of  by 
giving  the  mother  malt  extract,  which  not  only  aids  her 
own  digestion,  but  the  alcohol  which  is  in  it  in  small 
quantities,  and  also  the  diastase  or  nutritive  qualities 
of  the  grain,  possibly  stimulates  the  digestion  of  the 
child. 

The  one  potent  cause  of  intestinal  disturbance  in  chil- 
dren, in  summer,  is  stale  cow's  milk  ;  and  by  the  word 
stale  I  mean  any  milk  that  has  stood  some  time  after 
milking,  unless  it  has  been  boiled  or  subjected  to  intense 
heat.  My  own  experience  is  that  milk  fresh  from  the 
cow,  that  is  warm,  and  from  a  cow  that  is  healthy  and 
clean  and  has  been  carefully  fed,  can  be  given  to  a  child 
from  a  bottle  without  any  manipulation,  except  slight 
dilution,  and  can  be  digested,  whereas  the  same  kind 
of  milk  after  standing;  several  hours  might  cause  intesti- 
nal  disorder.  It  is  the  atmosphere  which  does  this  ;  it 
contains  germs  of  putrefaction,  very  much  more  potent 
in  the  summer,  and  abounding  in  our  large  cities.  It  is 
almost  impossible  to  distinguish  this  tainted  milk  from 


168  CHILDHOOD. 

that  which  is  fresh  and  pure,  the  changes  are  so  insidi- 
ous. 

We  have  said  that  the  diarrhoea  of  infancy  and  child- 
hood included  every  form,  from  simple  looseness  of  the 
bowel  to  cholera  infantum.  The  healthy  passages  should 
have  little  odor,  no  mucus,  no  curds;  should  have  a  con- 
sistency and  appearance  of  prepared  mustard.  Occasion- 
ally from  cold  or  slight  indigestion,  probably  from  sore 
mouth,  one  or  two  passages  may  change  in  appearance  ; 
they  may  become  greenish,  variegated  in  color ;  they 
may  become  more  frequent,  contain  a  few  curds.  If 
such  be  the  case,  and  the  child  is  nursed,  a  teaspoon- 
ful  of  sweet  oil,  with  the  same  of  solution  of  soda-mint, 
will  often  be  sufficient  to  bring  the  passages  to  their 
normal  condition.  If  the  mother  or  wet-nurse  show 
signs  of  biliousness,  a  dose  of  castor  oil  given  to  her 
will  probably  have  a  good  effect  upon  the  child.  If  the 
child  is  bottle-fed  and  curds  still  appear  in  the  passages, 
the  child  is  getting  food  too  full  of  curd,  or  its  diges- 
tion is  weakened.  The  bottle  should  be  omitted  for 
one  feeding,  and  some  barley-water  or  weak  chicken-tea 
be  substituted,  and  the  child's  digestion  stimulated  by 
giving  five  or  ten  drops  of  the  solution  of  lactopeptine 
or  a  grain  of  a  reliable  pepsin  in  a  tablespoonful  of 
water,  with  five  drops  of  whiskey,  before  the  next  feed- 
ing; or  as  much  of  a  powder  containing  equal  parts  of 
lactopeptine  and  subnitrate  of  bismuth  as  will  cover 
(not  heaped)  a  dime. 

If  the  child  does  not  seem  desirous  of  food,  under  no 
circumstances  press  it ;  should  it  crave  water,  allow  it 
to  drink,  not  iced  water ;  if  there  is  the  least  irritability 
of  the  stomach,  give  a  tablespoonful  of  lime-water  or  a 
teaspoonful  of  soda-mint  solution,  with  about  five 
drops  of  whiskey,  every  fifteen  minutes  or  half-hour, 
until  the  stomach  is  settled  and  the  child  quiet. 

The  evidences  of  catarrh  of  the  stomach  and  bowel 
are  pain,  restlessness,  heat  of  body  and  head,  with  un- 


DIARRH(EA.  169 

natural  coldness  of  the  extremities,  or  there  may  be 
fever.  The  character  of  the  pain  is  peculiar,  the 
child  will  cry  out  at  intervals,  draw  up  its  knees ;  the 
abdomen  will  be  tense,  the  muscles  firm  and  rigid  and 
distended  by  gas.  The  passages,  in  such  a  case,  will 
be  liquid  usually,  containing  curds,  lighter  in  color 
than  normal,  and  have  with  them  large  quantities  of 
slime  (mucus).  The  tongue  will  be  coated ;  the  child 
will  probably  crave  water  if  there  is  much  heat  or  dry- 
ness of  skin.  Now,  this  condition  can  be  brought  about 
at  any  time  of  year  from  exposure  to  cold,  or  from  irri- 
tating food,  but  it  is  usually  found  in  the  summer  in 
bottle-fed  babies.  Should  it  be  allowed  to  continue  for 
any  length  of  time  and  the  cause  not  removed, — by 
this  we  mean  the  child  still  subjected  to  the  intense 
city  heat  and  the  same  bottle-food, — the  diarrhoea  will 
soon  become  excessive,  evidences  of  inflammation  will 
appear :  vomiting,  intense  thirst,  a  diarrhoea  which  is 
almost  water,  tinged  with  green  and  containing  minute 
specks  of  greenish  matter,  finally  entire  loss  of  control 
over  the  bowels,  the  child  will  gradually  lose  conscious- 
ness and  die  of  exhaustion. 

True  cholera  infantum  is  not  a  very  common  disease, 
and  what  is  ordinarily  known  as  cholera  infantum,  such 
as  I  have  described,  is  simply  the  aggravation  of  an 
ordinary  simple  diarrhoea  which  has  been  improperly 
treated  at  the  commencement,  either  through  ignorance 
or  the  force  of  circumstances.  It  is  impossible  for  one 
to  so  guard  a  child  against  the  many  causes  that  con- 
spire to  produce  catarrhal  affections ;  the  change  of 
pasture  in  the  cow,  the  change  of  milk,  over-heated 
rooms,  sudden  change  of  weather,  are  often  beyond 
control.  But  as  soon  as  the  first  symptoms  appear, 
the  indications  for  treatment  are  absolute.  If  the 
digestive  derangements  are  very  mild,  simply  con- 
sisting of  a  furred  tongue,  eructation  of  sour  milk, 
or  the  appearance  of  curds  or  slime  in  the  stool  with- 
h  15 


170  CHILDHOOD. 

out  any  actual  diarrhoea,  weakening  the  bottle  with  a 
little  more  water,  taking  out  the  farinaceous  material  that 
has  probably  been  added  to  it,  giving  a  tablespoonful  of 
Murray's  fluid  magnesia,  and  allowing  the  child  to  drink, 
if  it  is  thirsty,  weak  gum-arabic  water  or  toast-water, 
will  probably  be  all-sufficient.  But  if  the  child  has 
pain  in  addition  to  these  symptoms,  the  treatment  is 
different.  For  such  cases,  stop  the  bottle-food  at  once, 
and"  when  food  is  required  give  the  child  a  mixture 
containing  a  tablespoonful  of  cream,  a  tablespoonful  of 
fresh  milk,  and  two  tablespoonfuls  of  lime-water.  Be 
careful  not  to  overload  its  stomach  ;  feed  it  at  frequent 
intervals,  very  little  at  a  time.  If  it  is  thirsty,  allow 
it  to  drink  of  the  gum-arabic  water  or  toast- water.  If 
the  child  is  a  year  old  or  more,  when  the  thirst  is 
very  great,  and  especially  if  it  is  in  summer,  milk 
can  be  omitted  altogether  from  the  diet,  and  barley- 
water — made  by  adding  an  ounce  of  barley,  crushed, 
to  a  quart  of  water,  boiled  for  twenty  minutes  and  then 
strained — can  be  given  with  condensed  milk,  one  part 
to  twelve ;  or  to  this  can  be  added  two  tablespoonfuls 
of  lime-water  when  the  bottle  is  made  up,  and  the  child 
be  given  every  two  or  three  hours  ten  drops  of  whiskey, 
as  a  drink,  in  one  ounce  of  water,  with  one  ounce  of 
lime-water.  The  white  of  an  egg  dissolved  in  a 
tumblerful  of  warm  water,  to  which  is  added  a  tea- 
spoonful  of  glycerin  and  a  dessertspoonful  of  orange- 
flower  water,  can  be  kept  in  a  cool  place  and  given 
occasionally,  as  a  drink,  if  the  child  is  thirsty. 

In  cases  just  described,  the  medicinal  treatment  should 
be  to  clear  the  bowel  at  once  of  the  accumulated  curds 
and  mucus,  and  relieve  the  congestion ;  and  for  this 
purpose  a  dose  of  castor  oil  may  be  given  as  follows :  a 
teaspoonful  of  castor  oil,  ten  drops  of  aromatic  syrup 
of  rhubarb,  and  a  dessertspoonful  of  warm  soda-mint 
(solution).  A  warm  foot-bath  should  be  given,  and 
over  the  child's  abdomen  should  be  placed  a  mustard 


DIARRHCEA.  171 

poultice  (half  flour),  a  spice  poultice,  or  flannels  wrung 
out  in  hot  water,  over  which  is  sprinkled  some  essence 
of  ginger.  After  the  oil  has  operated  once,  and  a 
large  mass  of  curds  and  mucus  has  been  expelled  from 
the  bowels,  the  subsequent  operations  will  be  noted  to 
be  of  a  more  natural  color,  but  very  cautiously  in- 
deed should  the  mother  return  to  the  ordinary  bottle- 
food.  If  the  weather  is  very  warm,  the  child  should  be 
taken  daily  to  some  shady  spot  in  the  suburbs,  where 
the  air  is  purer  and  fresher  than  in  the  city.  If  it  is  at 
all  possible,  it  should  for  several  hours  a  day  breathe 
the  air  that  comes  off  the  water.  There  is  no  city 
charity  that  should  receive  more  encouragement  than 
that  which  gives  the  river  excursions  to  these  poor 
children.  A  few  moments'  ride  in  a  ferry-boat  will  often 
revive  a  child  that  is  being  exhausted  by  the  heat  and 
succumbing  to  summer-complaint.  The  nervous  sys- 
tem has  given  out,  it  has  lost  its  control  over  the  blood- 
vessels, and  the  serum  or  watery  portion  of  the  blood, 
that  contains  all  the  nourishment,  leaks  into  the  bowel 
and  is  drained  away.  The  little  sufferer  dies  abso- 
lutely of  hemorrhage, — white  hemorrhage.  That  is  the 
reason  these  teething  city  babies  so  rapidly  emaciate; 
that  is  the  reason  they  crave  water  to  supply  that 
which  is  lost.  A  child,  then,  should  be  treated  in  such 
a  way  that  its  nervous  system  will  be  strengthened 
and  given  once  more  control.  Fresh,  pure  air, — either 
the  air  from  the  country  or,  better,  the  air  from  the 
water,  or,  better  still,  the  air  from  the  sea.  Its  tissues 
should  be  braced  by  stimulating,  cooling  applications  ; 
it  should  be  sponged  with  vinegar  and  water  or  alcohol 
and  water ;  its  feet  should  be  soaked  in  water  contain- 
ing a  little  mustard  to  stimulate  its  circulation ;  the 
room  should  be  kept  as  cool  as  possible,  thoroughly 
aired,  free  from  all  contamination  by  sewer-air  or  putre- 
fying matters,  and  what  food  is  given  should  be  abso- 
lutely pure  and  untainted. 


172  CHILDHOOD. 

In  all  these  cases,  if  in  the  city,  avoid  milk  that  is 
raw,  and  starches  of  all  kinds,  even  should  they  be 
thoroughly  cooked  or  boiled.  After  a  child  has  taken  a 
dose  of  oil,  it  can  be  fed  on  condensed  or  evaporated 
milk,  and  wine- whey  given  to  it  as  a  drink,  a  wine- 
glassful  every  three  or  four  hours  should  it  exhibit 
any  symptoms  of  exhaustion  ;  and  after  the  bowels  have 
thoroughly  returned  to  their  normal  condition,  the  food 
can  be  changed  to  either  boiled  milk  prepared  for  the 
bottle,  or  some  of  the  other  preparations  mentioned  in 
the  chapter  on  that  subject.  In  these  cases  peptonized 
milk  is  often  very  valuable. 

It  is  well  for  a  mother  to  recognize  the  fact  that  her 
child  should  abstain  entirely  from  food  in  these  earlier 
stages  of  diarrhoea,  especially  in  summer,  certainly  until 
her  physician  has  seen  the  case.  She  should  make  it 
a  rule  to  allow  the  child  to  drink  freely,  if  it  wishes 
it,  of  gum  arabic  or  toast- water ;  give  small  pieces  of 
cracked  ice,  wine-whey,  Valentine's  beef  extract  or  the 
fresh  expressed  beef-juice,  or  some  chicken-broth  ; 
indeed,  the  beef-juice  and  chicken-broth,  given  with 
gum-arabic  water,  make  a  nutritious  and  harmless 
diet  in  all  of  these  cases.  This  hygienic  treatment 
alone,  in  the  earlier  stages  of  a  diarrhoea,  will  be  of 
very  great  advantage,  and  will  aid  the  doctor  most 
assuredly  by  paving  the  way  for  that  medical  treatment 
which  he  may  find  it  necessary  to  institute  to  bring 
about  a  normal  condition. 

Of  course,  a  diarrhoea  may  come  on  very  suddenly, 
with  great  intensity,  and  be  fatal  within  a  few  hours. 
These  cases  are  called  cholera  infantum.  Their  sudden- 
ness is  appalling ;  their  treatment  should  be  immediate. 
Their  cause  seems  to  be  a  union  of  all  those  conditions, 
one  of  which  alone  is  sufficient  to  cause  a  diarrhoea ;  it 
is  a  blood-poisoning,  originating,  possibly,  in  the  ab- 
sorption of  some  germ  of  putrefaction,  and  aggravated  by 
improper  diet,  lowered  vitality  on  the  part  of  the  child, 


DIARRHCEA.  173 

impure  air,  and  intense  heat,  continuing  unabated  day 
and  night.  Cases  may  originate  in  this  way,  coming 
suddenly  upon  children  who  have  been  previously  in 
good  health,  or  this  condition  may  be  the  result  of  a  pro- 
tracted and  neglected  simple  diarrhoea.  The  mother's 
duty  in  these  cases  is  always  to  attend  to  the  hygiene, 
and  by  hygiene  we  mean  the  attending  to  proper  food, 
judicious  bathing,  and  the  placing  of  her  child  where 
it  can,  for  at  least  a  part  of  the  day,  breathe  pure  air. 

But  the  doctor's  duties  are  equally  important.  My 
object  is  not  to  instruct  mothers  how  to  take  the  doc- 
tor's place, — his  duties  are  distinct  from  hers ;  but  it  is 
simply  to  give  her  an  intelligent  understanding  of  what 
the  doctor  means  when  he  lays  down  certain  rules  which 
are  to  be  carried  out  in  the  nursing  and  management  of 
her  child,  without  which  the  medical  treatment  would 
be  absolutely  of  no  avail.  It  would  be  ridiculous  to 
give  a  child  morphia  and  sulphuric  acid  for  a  severe 
case  of  cholera  infantum,  or  salicylic  acid  or  bismuth 
and  pepsin,  and  at  the  same  time  to  have  the  baby  kept 
in  a  close,  ill-smelling  room,  and  endeavor  to  quench 
its  thirst  by  the  free  administration  of  tainted  cow's 
milk  given  through  a  dirty  nursing-bottle ;  and  yet 
how  often,  even  in  families  that  should  know  better, 
do  we  find  appalling  ignorance  in  regard  to  these  most 
important  matters. 

If  the  child  vomits  much,  food  by  the  mouth  should 
be  avoided  and  nutritious  injections  given  instead,  such 
as  a  raw  egg  beaten  with  warm  water  and  five  or  ten 
drops  of  brandy  or  peptonized  milk,  about  one  ounce 
every  two  hours. 


15* 


174  CHILDHOOD. 


CHAPTER  XV.1 

WHOOPING-COUGH. 

Its  Character — Its   Complications — The  Nursing  of  it — Diet — 
Treatment. 

It  is  not  whooping-cough  alone  that  gives  us  such 
a  large  mortality :  it  is  fatal  in  its  complications.  In 
other  words,  being  a  disease  that  lasts  six  weeks,  or 
sometimes  two  months,  parents  or  nurses  get  careless 
and  the  babies  die  from  debility,  pneumonia,  bronchitis, 
bowel-complaint,  or  some  complication  caused  by  the 
great  straining  induced  by  the  cough. 

Let  us  for  a  moment  study  the  nature  of  this  disease 
from  the  most  recent  investigations  of  the  subject.  It 
has  been  well  known  and  thoroughly  described  by 
medical  writers  for  many  years ;  certainly  for  over 
three  hundred  years  it  has  been  acknowledged  as  a 
contagious  affection,  not  simply  a  nervous  cough. 

It  is  a  disease  usually  occurring  in  childhood,  but 
which  is  limited  to  no  particular  age.  I  once  saw  a 
child  born  with  it  undoubtedly,  and  we  frequently 
hear  of  it  at  the  age  of  sixty  or  over.  It  is  rare  for 
a  person  to  have  it  twice.  It  begins  as  an  ordinary 
cold,  though,  after  the  child  has  had  apparently  a  cold 
in  its  head  and  a  dry  cough  for  some  days,  the  cough 
comes  on  in  paroxysms,  usually  upon  taking  food,  or 
following  excitement ;  but  it  tries  to  suppress  the 
cough,  and  in  doing  so  the  face  gets  much  congested. 
Soon  the  paroxysm  of  coughing  will  provoke  vomit- 
ing, and  then  the  whoop,  or  drawing-in  of  the  breath, 

1  This  chapter  appeared  as  an  article  in  Babyhood  for  Septem 
her,  1886,  and  is  republished  by  permission  of  the  publishers. 


WHOOPING- CO  UGH  175 

after  several  forcible  expulsive  coughing-spells  have 
taken  place.  These  paroxysms  increase  in  force  and 
frequency;  the  child's  face  becomes  blue  and  puffy; 
the  little  sufferer  seizes  on  the  nearest  obstacle  for  sup- 
port ;  the  spells  are  agonizing  to  behold ;  finally,  after 
successive  coughing-spells,  each  followed  by  a  gasping 
which  produces  the  whoop,  a  violent  attack  of  vomit- 
ing takes  place,  mucus  runs  from  the  mouth  and  nose, 
and  the  child  falls  back  limp  and  exhausted,  in  a  few 
moments  to  resume  its  play,  without  any  evidence,  ex- 
cept the  puffing  about  the  eyes,  of  any  trouble  in  the 
respiratory  tract.  This  is  the  characteristic  feature  of 
the  disease. 

It  is  impossible  at  first  to  make  a  definite  statement 
as  to  the  existence  of  the  disease ;  it  is  only  after  the 
first  week  or  ten  days,  when  the  cough  assumes  the 
features  above  described,  that  one  is  certain ;  and  espe- 
cially is  this  the  case  if  the  child  has  been  exposed  to 
the  disease.  It  is  not  the  most  contagious  disease  of 
childhood,  not  nearly  as  much  so  as  measles,  chicken-pox, 
or  scarlet  fever ;  it  requires,  in  all  probability,  either 
the  breath  direct  from  another  case,  or  inhaling  the  air 
of  a  crowded  room  or  car  in  which  a  child  with  the 
disease  has  been. 

In  the  article  on  scarlatina  the  period  of  incubation 
is  explained, — that  time  which  elapses  between  the  direct 
exposure  to  the  poison  of  a  disease  or  the  absorption 
of  its  contagious  principles,  and  that  of  the  appearance 
of  the  first  symptoms.  For  whooping-cough  this  is 
supposed  to  be  about  two  weeks,  as  nearly  as  we  can 
calculate  it. 

The  disease  is  a  contagious  one — that  we  all  know. 
Its  contagious  material  resides  undoubtedly  in  the  breath 
of  the  one  affected  with  it ;  it  is  taken  up  probably  by 
the  air  during  its  passage  over  the  secretions  from  the 
throat  and  nose.  The  air  probably  retains  it  for  a  long 
time,  and  these  secretions  usually,  at  the  height  of  the 


1 76  CHILDHOOD. 

disease,  being  excessive,  are  easily  communicated  from 
one  child  to  another  in  play,  by  kissing,  etc.,  or  they  dry 
and  are  finely  pulverized,  and  are  scattered  throughout 
a  badly-ventilated  room.  During  the  whole  period  of 
excessive  secretion,  from  the  first  week  till  the  cough 
almost  disappears,  the  child  with  whooping-cough  is 
capable  of  giving  the  disease  to  others  with  whom  it 
comes  in  contact. 

It  is  almost  criminal,  then,  for  parents  and  nurses  to 
take  these  children  into  open  squares  or  parks,  places  of 
amusement  where  healthy  children  congregate.  And  yet 
this  is  done  daily. 

Investigators  have  detected  by  the  microscope  certain 
germs,  which  have  since  been  found  in  all  cases  of  this 
disease,  in  the  sputum  and  in  the  secretions  from  the 
nose.  In  all  probability  these  come  in  contact  with  the 
mucous  membrane,  are  directly  absorbed,  multiply  and 
diffuse  themselves  through  the  blood  during  the  period 
of  incubation,  or  act  in  some  way  especially  upon  the 
delicate  membrane  of  the  nose  and  respiratory  tract. 
Animals  have  been  inoculated  with  this  mucus  and  have 
exhibited  all  the  symptoms  of  the  disease. 

It  is  a  disease  that  has  a  regular  course  of  its  own  to 
run  if  not  treated.  In  Japan  it  is  called  the  "  hundred- 
day  disease."  It  usually,  in  mild  cases,  lasts  about  two 
months,  possibly  sometimes  three,  though  active  treat- 
ment and  careful  nursing  will  shorten  it  to  a  very  great 
extent,  or  make  it  very  much  less  severe. 

It  is  not  for  us  here  to  examine  carefully  the  medical 
treatment  of  this  disease.  As  far  as  is  known,  no  drug 
will  at  once  cut  short  an  attack,  but  the  physician  has 
many  resources  at  his  command  that  will  mitigate  its 
severity,  diminish  the  intensity  of  its  paroxysms,  lessen 
the  great  danger  to  hemorrhages,  to  heart-disease,  to  dis- 
ease of  the  lungs,  whose  delicate  tissue  is  easily  damaged 
by  forcible  coughing ;  and  it  is  for  him  to  decide  what  is 
especially  advisable  for  each  particular  case.     He  will 


WHO  OP  TNG-  CO  UGH.  177 

probably  give  the  child  belladonna  or  quinine,  or  pos- 
sibly recommend  an  infusion  of  chestnut-leaves.  At 
night  he  may  find  it  necessary  to  give  the  bromides  of 
potassium  or  ammonium,  with  chloral. 

To  the  mother  belongs  the  equally  important  duty  of 
warding  oif  danger  by  careful  nursing,  by  guarding  her 
child  against  exposure,  by  proper  clothing,  careful  and 
nutritious  diet,  and  abundance  of  fresh  air. 

Every  child  with  whooping-cough  should  have  pure, 
fresh  air,  and  be  out  of  doors  as  much  as  possible  in  suit- 
able weather.  The  sea-air,  when  accessible,  is  greatly 
to  be  desired ;  the  moisture  in  it,  and  possibly  the  salt, 
help  to  liquefy  the  secretions.  It  has  a  sedative  eifect, 
allaying  nervous  irritability ;  then  it  is  always  fresh 
and  pure,  and  this  is  most  important  in  the  treatment. 
The  fresh  air  prevents  debility,  and  therefore  wards  off 
those  serious  complications  due  to  "  run  down"  and  loss 
of  appetite.  If  the  patient  is  obliged  to  remain  in  the 
city,  it  is  well  to  dress  the  child  warmly,  make  a  play- 
room of  the  top  story  of  the  house,  and  open  the  win- 
dows to  insure  a  constant  access  of  fresh  air,  purer  than 
that  directly  from  the  street. 

Diseases  of  the  lungs  are  most  to  be  dreaded  as  a 
complication,  therefore  all  children  suffering  from 
whooping-cough  should  have  some  woollen  garment, 
light  in  summer  and  heavier  in  winter,  covering  the 
entire  body.  It  is  a  mistake  to  clothe  children  too 
warmly ;  active  perspiration  during  play  will  only  in- 
vite colds  should  the  child  be  exposed  to  a  draught. 
Indeed,  this  is  the  case  with  all  children,  sick  or  well. 
Often  severe  catarrhs  are  brought  about  in  children 
overclothed. 

A  child  should  be  accustomed  to  a  daily  bath  or 
sponging  in  cool  water ;  its  chest,  back,  and  feet  should 
be  thoroughly  sponged,  and  then  reaction  brought 
about  by  a  good  rubbing. 

There  is  a  curious  close  relationship  between  the  feet 


178  CHILDHOOD. 

and  the  mucous  membrane  of  the  air-passages.  We  all 
know  how  quickly  wet  feet,  when  exposed  to  draughts, 
will  give  a  catarrh.  A  foot-bath  of  cool  or  cold  water 
at  night  will  do  much  to  lessen  the  liability  to  colds. 

A  child  with  whooping-cough  should  receive  a  full 
supply  of  digestible,  nutritious  food ;  gruels,  soups,  or 
broths ;  Mellin's  or  Horlick's  food ;  a  light  dinner  of 
chicken  or  steak,  if  it  is  old  enough,  vegetables  such  as 
well-cooked  young  beets,  spinach,  cauliflower,  roasted 
or  mashed  potatoes,  and  stewed  fruits,  as  apples  or 
peaches,  that  will  keep  the  bowels  regular..  Milk 
should,  of  course,  be  plentifully  used,  and  it  is  well 
to  dilute  it  with  lime-water,  or  Vichy  water,  to  prevent 
it  curdling  in  heavy  masses.  A  child  is  apt  to  have 
a  paroxysm  and  vomit  a  meal  just  after  it  is  taken. 
Some  light,  nourishing  food  should  at  once  be  given 
which  will  be  retained, — either  a  cup  of  broth  with 
barley,  or  milk  and  lime-water,  or  some  sherry  and 
water  with  sponge-cake,  will  serve  the  purpose. 

I  have  often  noticed  that  a  copious  discharge  of  a 
thick  mucus  will  follow  a  paroxysm,  and  that  until 
this  discharge  takes  place  the  cough  will  be  repeated. 
The  mother  should  recognize  this  fact  and  do  all  in 
her  power  to  aid  the  child.  If  it  is  an  infant  it  can  be 
accomplished  by  turning  the  child  over  on  its  stomach, 
with  the  head  low,  and  detaching  the  mucus  with  her 
finger  from  the  mouth.  If  the  child  is  older  it  should 
be  taught  to  blow  its  nose  thoroughly,  or  probably  by 
inducing  vomiting  at  once  relief  will  come  and  the  par- 
oxysm be  cut  short.  A  child  can  be  very  materially 
aided  in  this  way  and  the  severe  strain  avoided. 

A  large  amount  of  the  thick  mucus  which  cannot  be 
gotten  rid  of  by  the  cough  may  seriously  threaten  suffo- 
cation. In  such  a  case  a  teaspoonful  of  syrup  of  ipecac, 
or  the  same  of  powdered  alum  mixed  with  syrup,  should 
be  at  once  given  to  provoke  immediate  vomiting. 

Counter-irritation  to  the  chest  by  means  of  various 


WHO  OPING-  CO  UGH.  179 

liniments  is  certainly  valuable ;  a  suitable  one  will  be 
selected  by  the  physician,  containing  possibly  the  oil  of 
amber,  croton  oil,  or  turpentine,  in  soap  liniment,  or 
possibly  chloroform  liniment.  My  own  experience  has 
taught  me  that  the  spray  from  an  atomizer  is  a  valuable 
aid  in  the  treatment  of  this  disease.  It  can  be  used  to 
make  the  thick  mucus  more  watery,  and  also  as  a  means 
of  carrying  medicaments  directly  to  the  surface.  But 
it  requires  an  immense  amount  of  patience  on  the  part 
of  the  mother.  The  nose  and  throat  should  receive  in 
this  way  a  thorough  treatment  five  or  six  times  a  day. 
The  nose  should  be  frequently  cleansed  by  the  spray 
of  Dobell's  solution  (carbolic  acid,  borax,  soda  and  gly- 
cerin). 

I  have  endeavored  to  impress  upon  my  readers 
that  whooping-cough  is  a  distinct  disease  with  a  his- 
tory of  its  own,  and  belongs  to  the  same  category  as 
the  other  contagious  affections  of  childhood.  I  have 
avoided  discussion  of  its  medical  treatment;  that  be- 
longs to  the  doctor.  Whatever  tends  to  weaken  the 
child  invites  most  serious  complications,  and  these  are 
the  causes  of  the  great  mortality  mentioned.  All  patent 
nostrums  of  uncertain  combination,  or  of  such  composi- 
tion as  to  derange  the  secretions,  produce  constipation, 
loss  of  appetite,  are  to  be  avoided  by  all  means.  Good 
nursing  is  more  than  half  the  battle.  Fresh  air,  proper 
clothing,  good,  nutritious  diet,  regulation  of  the  bowels, 
efforts  to  mitigate  the  intensity  of  the  paroxysms  by 
aiding  the  child  in  discharging  the  mucus,  giving  it  an 
easy  and  comfortable  position  which  relieves  the  strain, 
supporting  it  for  the  same  purpose,  pressure  of  the  hand 
over  the  eyes  to  prevent  their  strain, — all  these  are  as 
important  as  the  medical  treatment. 


1 80  CHILDHOOD. 


CHAPTER    XVI.1 

SCAELET  FEVEE. 

Its  Cause — The  Eeasons  why  it  does  not  appear  to  be  as  Contagious 
as  other  Similar  Affections — The  First  Symptoms — Its  Nursing 
— Complications — Sequelae. 

Scaelatina  is  the  Latin  name  for  scarlet  fever  in 
all  its  forms,  those  most  grave  and  those  most  mild. 
There  is  another  point  of  great  importance,  which  is, 
that  the  mildest  cases  of  scarlet  fever  have  often  the 
saddest  ending,  owing  to  the  want  of  attention  to  those 
details  of  nursing  which  exclude  the  possibility  of  serious 
complications  by  exposure  or  neglect.  Every  doctor 
has  heard  the  statement,  when  questioning  in  regard  to 
the  antecedents  of  dropsy  or  possibly  some  destructive 
disease  of  the  ear :  "  My  child  had  only  scarlatina  ;  it 
was  so  mild  that  really  we  did  not  see  the  necessity  of 
punishing  the  little  one  by  confining  her  to  her  bed  or 
room." 

Scarlatina  is  scarlet  fever,  and  a  mild  attack  of  this 
most  treacherous  disease  may  become  as  serious  ulti- 
mately as  a  very  severe  attack, — often  more  so,  as  the 
one  will  be  cared  for  and  the  other  'neglected.  It  is, 
therefore,  necessary  thoroughly  to  understand  the  prin- 
cipal features  of  this  disease. 

It  is  undoubtedly  caused  by  the  entrance  into  the 
system  of  a  something  which  has  all  the  characteristics 
of  matter.  This  something,  which,  as  we  shall  see,  re- 
quires a  certain  time  thoroughly  to  infect  the  blood  in 


1  This  chapter  appeared  as  an  article  in  Babyhood  for  February, 
1886 ;  it  is  now  out  of  print,  and  is  republished  by  permission  of 
the  publishers. 


SCARLET  FEVER.  181 

which  it  circulates  before  the  symptoms  of  the  disease 
show  themselves,  is  called  a  germ  ;  this  germ  has  weight, 
proven  by  the  fact  that  it  occupies  a  certain  space  ;  can 
be  carried  in  clothing  or  merchandise,  or  by  the  air ;  it 
remains  in  its  position  ;  it  does  not  evaporate  or  become 
gaseous ;  it  is  transmissible,  and  at  the  same  time  is 
very  subtle,  can  insinuate  itself  in  cracks  and  crevices, 
in  the  breath  of  individuals,  in  their  hair,  in  clothing, 
in  the  mails.  It  is  a  living  material,  whose  vitality  may 
lie  dormant  for  years,  and  then,  like  grain,  grow  under 
favorable  conditions ;  it  can  be  destroyed  by  heat,  prob- 
ably by  intense  cold,  or  by  chemical  agents.  But  it  is 
unlike  the  grain  in  one  most  important  characteristic, 
which  is  this  :  a  grain — say  of  wheat — may  have  re- 
mained dormant  since  the  time  of  the  Pharaohs,  and, 
taken  from  a  mummy-coffin,  placed  in  heat  and  mois- 
ture, it  will  sprout,  but  will  only  produce  one  stalk. 
The  germ  of  scarlatina  may  lie  dormant,  but  when 
aroused  into  activity  by  suitable  associations  it  will  act 
as  a  leaven — as  a  ferment ;  this  minutest  microscopic 
object  will  perpetuate  its  species  until  it  will  invade 
every  organ  and  tissue  of  the  body.  On  this  account 
this  disease  is  classed  as  zymotic  (from  zyma,  ferment). 

Scarlet  fever  can  be  communicated  by  infected  milk ; 
and,  as  far  as  we  know,  the  milk  has  only  to  stand  in 
the  room  where  the  disease  exists  or  has  existed,  to  ab- 
sorb the  germs,  which  are  so  subtle,  so  light,  and  yet  so 
tenacious,  as  to  float  in  the  air  and  adhere  to  particles  of 
dust. 

We  all  know  how  much  dust  is  constantly  floating  in 
the  air ;  let  a  beam  of  sunlight  pass  through  an  opening 
in  the  shutter,  and  we  can  readily  see  how  the  scales  of 
the  skin  from  the  body,  pieces  of  lint,  etc.,  can  carry 
these  microbes  which  may  be  thrown  off  in  the  mucus 
from  the  nostrils  and  mouth  or  in  the  perspiration,  and 
even  in  the  urine. 

Not  only  are  these  secretions  germ-carriers,  that  is, 
16 


182  CHILDHOOD. 

contagious, — and  they  have  all  been  proven  so  by  di- 
rect inoculation, — but  the  passages  from  the  bowels  as 
well  as  the  urine  are  so.  In  that  way  sewer-air  may 
be  a  means  of  their  conveyance ;  drinking-water  also, 
as  well  as  the  vapor  from  the  soil  on  which  these  mat- 
ters have  been  thrown.  Bear  in  mind,  then,  that  the 
scarlatina  poison  can  be  carried  in  this  way  hundreds 
of  miles ;  that  it  does  not  need  the  personal  contact  of 
individuals ;  that  it  retains  its  vitality  for  months  and 
even  years  unless  it  be  subjected  to  certain  influences 
that  either  entirely  destroy,  or  deprive  it  of,  its  malig- 
nancy; these  are  intense  heat,  especially  boiling  or 
steam,  plenty  of  fresh  air,  and  certain  chemical  sub- 
stances, as  chlorine,  sulphurous  acid,  and  others. 

The  poison  of  scarlatina  is  either  inhaled  by  the 
individual,  or  swallowed ;  it  is  then  taken  up  by  the 
circulation,  and,  finding  itself  surrounded  by  material 
which  develops  it,  vivifies  it,  becomes  rapidly  repro- 
duced, and  the  symptoms  of  the  disease  show  them- 
selves. This  period  between  the  reception  of  the  poi- 
son and  the  appearance  of  the  symptoms  is  called  the 
period  of  incubation  ;  this  is  known  to  be  from  one  to 
six  days ;  in  some  cases  longer. 

Unless  we  definitely  know  that  the  child  has  been 
exposed  to  the  disease,  we  cannot  detect  its  presence  till 
the  rash  appears,  and  this  takes  place  within  twenty-four 
hours  of  the  first  symptoms.  What  are  these  ?  Chill 
or  convulsions,  delirium,  intense  headache,  sore  throat, 
swelling  of  the  glands  of  the  neck  behind  the  jaw  (ker- 
nels), nausea  or  vomiting,  associated  with  high  fever, 
bounding  pulse,  and  dry  skin.  The  first  three  of  these 
may  be  absent  in  mild  cases ;  the  others  are  nearly  al- 
ways present  to  a  greater  or  less  degree. 

Under  such  circumstances  what  should  be  done? 
The  child  should  be  put  to  bed  by  itself  in  a  separate 
room  ;  it  should  have  a  hot  foot-bath,  the  water,  with 
or  without  mustard,  about  as  warm  as  the  hand  can 


SCARLET  FEVER.  183 

bear.  It  should  be  lightly  covered  with  a  sheet  and 
light  blanket ;  it  should  be  kept  as  quiet  as  possible, 
and  given  frequently  warm  milk  in  small  quantities, 
with  lime-water  or  so-called  "cambric  tea,"  and  no 
solid  food.  Do  not  purge ;  in  fact;  avoid  all  medicine 
— with  the  exception  possibly  of  a  little  sweet  spirits 
of  nitre,  a  teaspoonful  to  half  a  tumbler  of  sweetened 
water — until  the  doctor  arrives.  At  the  end  of  from 
six  to  eighteen  hours  the  rash  will  appear.  It  will  be 
noticed  in  patches,  fading  into  the  normal  color  of  the 
skin,  on  the  neck,  shoulder,  and  chest,  then  on  the  ab- 
domen, and  finally  on  the  trunk,  arms,  and  legs.  It 
resembles  the  redness  produced  by  a  mustard-plaster, 
and  feels  rough  to  the  hand  when  fully  developed. 

The  disease  is  now  fully  determined ;  the  fever  is 
high,  the  restlessness  is  usually  increased,  the  throat 
symptoms  are  marked,  and  the  secretions  are  dimin- 
ished. The  most  urgent  care  is  now  to  be  taken  in  the 
nursing.  All  superfluous  hangings,  such  as  curtains, 
pictures,  should  be  removed  from  the  room.  The  child 
should  be  nursed  by  one  who  has  all  the  details  of  the 
case  under  her  charge,  who  should  wear  the  simplest 
kind  of  clothing,  that  can  be  daily  changed  and  washed 
or  aired.  She  should  have  an  adjoining  room  in  which 
to  keep  her  clothes  and  make  her  toilet.  Everything 
that  comes  in  contact  with  the  child,  such  as  towels, 
brushes,  blankets,  or  sheets,  should  be  kept  rigidly 
separate,  and  thoroughly  boiled  and  aired  before  being 
taken  from  the  premises. 

The  room  should  be  kept  thoroughly  ventilated, 
either  by  keeping  open  a  window  in  the  adjoining 
room  or  by  some  arrangement  attached  to  the  window 
of  the  sick-room  which  will  allow  the  ingress  and  egress 
of  air  without  a  draught;  the  temperature  should  be 
kept  at  about  68°,  and  regulated  by  a  thermometer. 
If  the  room  receives  its  heat  from  a  furnace,  the  hot  air 
should  be  made  to  pass  over  a  pail  of  water  containing 


184  CHILDHOOD. 

either  diluted  Labarraque's  solution  or  Piatt's  chlorides, 
and  a  towel  with  one  end  dipped  in  such  a  solution  should 
be  tacked  over  the  register.  If  there  be  a  stove,  or,  better 
than  all,  an  open  grate,  these  solutions  can  be  placed 
near  by,  so  as  to  be  readily  evaporated  and  distributed 
throughout  the  room. 

The  chamber  should  always  contain  some  such  solu- 
tion in  which  to  receive  the  excreta.  A  small  quantity 
of  urine  should  daily  be  collected  in  a  clean  vessel  for 
the  doctor's  examination.  It  is  usual  to  anoint  the 
child  with  some  greasy  substance ;  this  allays  the  intense 
itching  or  prickling,  which  is  most  annoying,  it  softens 
the  skin,  which  is  inflamed  and  swollen,  it  depresses  the 
fever  to  a  certain  extent,  and  it  serves  to  collect  the 
scales  of  the  skin,  which,  if  shed,  serve  as  carriers  of 
contagion,  and  which  are  usually  shed  in  flakes.  The 
child  should  have  its  mouth  washed  once  or  twice  daily, 
as  also  other  parts  of  its  body,  for  purposes  of  clean- 
liness, and  the  water  used  can  contain  either  very  diluted 
Labarraque's  solution,  vinegar,  Listerine,  or  phenol- 
sodique,  and  possibly  the  doctor  will  order  the  frequent 
use  of  the  hand-spray,  using  some  good  disinfectant  for 
the  throat  in  these  cases. 

What  are  the  dangers  incident  to  scarlet  fever? 
Extensive  disease  of  the  throat  with  complications  of 
diphtheria,  disease  of  the  ear  with  permanent  deafness, 
disease  of  the  eyes ;  more  important  than  all,  serious 
complications  due  to  inflammation  of  the  kidneys,  made 
evident  by  dropsy,  convulsions,  often  ending  fatally. 
To  avoid  these,  which  may  take  place  in  the  mildest 
cases,  from  exposure  to  draughts,  imprudence,  and  want 
of  cleanliness  and  attention,  great  care  is  necessary. 

The  question  of  bathing  or  sponging  a  child  ill  with 
scarlatina  must  be  decided  by  the  doctor.  Sometimes 
it  is  necessary  to  depress  the  temperature,  as  a  prolonged 
high  temperature  will  kill ;  but  in  all  cases,  however 
severe,  cleanliness  should  be  insisted  upon, — the  face 


SCARLET  FEVER.  185 

and  hands,  the  eyes,  ears,  mouth,  and  genitals,  should 
be  kept  clean  and  free  from  secretions. 

The  temperature  usually  remains  high  till  the  decline 
of  the  disease, — about  the  fourth  or  fifth  day  in  ordinary 
cases.  As  soon  as  the  fever  has  subsided  and  the 
eruption  has  faded,  and  the  skin-shedding  is  well 
established,  it  is  customary  to  sponge  the  body  off  thor- 
oughly in  tepid  water,  and  clean  the  head,  using  a  fine 
sponge  or  soft  linen,  avoiding  draughts,  and  keeping 
the  body  well  covered,  with  the  exception  of  the  part 
being  washed.  I  have  found  a  preparation  known  as 
"  Little's  Soluble  Phenyl"  admirable  in  this  connection, 
a  few  drops  of  it  being  added  to  the  water.  It  is  dis- 
infectant and  leaves  the  skin  soft.  As  kidney-troubles 
usually  show  themselves  during  or  following  the  scaling 
stage,  greater  precautions  than  ever  are  to  be  used  at 
this  time.  The  urine  should  be  examined  every  day  or 
two.  The  diet  should  be  mostly  liquid, — that  is,  milk, 
or  milk  and  lime-water,  gruels,  soups,  and  such  like; 
the  child  should  be  encouraged  to  drink  freely  of  water, 
the  bowels  must  move  daily,  if  necessary  by  an  enema, 
and  under  no  circumstances  should  the  patient  be  per- 
mitted to  leave  the  room  unless  great  precautions  have 
been  previously  taken.  In  this  climate  we  have  to  be 
very  particular,  owing  to  the  sudden  changes  of  tempera- 
ture, and  it  is  far  better  that  the  child  should  be  kept 
in-doors  a  few  days  longer  than  the  parents  usually 
think  necessary  than  to  run  the  great  risk  of  kidney- 
diseases,  or  rheumatism  with  its  serious  effect  upon  the 
heart,  which  may  follow  such  exposure. 

After  the  child  has  had  several  changes  of  under- 
clothing, has  been  well  washed  a  number  of  times,  and 
at  least  two  weeks  have  elapsed  since  the  disease  declined, 
it  can  be  removed  to  another  room,  and  the  sick-room 
fumigated.  This  should  be  done  by  igniting  some 
sulphur  in  a  saucer  in  the  room,  all  the  windows  and 
doors  having  been  previously  closed  and  the  cracks 

16* 


186  CHILDHOOD. 

stuffed.  After  twenty-four  hours  the  room  can  be 
opened  and  full  ventilation  permitted.  All  the  furniture 
should  be  wiped  with  a  damp  cloth,  and  the  paint-work 
washed  with  water  containing  the  chlorides  or  borax. 
The  room  should  remain  unoccupied  for  some  time  and 
be  thoroughly  aired. 

The  school-room  is  undoubtedly  the  place  most  to  be 
blamed  for  the  distribution  of  scarlatina  poison.  To  get 
rid  of  the  other  children  they  are  sent  there  whilst  the 
mother  is  nursing  the  sick  one  at  home.  Some  children 
possess  a  remarkable  immunity  from  this  disease,  never- 
theless they  act  as  carriers  of  contagion.  Then,  again, 
servants  or  child-nurses  often  carry  it  in  their  heavy 
shawls  from  house  to  house,  taking  it  directly  from  a 
sick-room  to  the  nursery. 

Scarlatina,  as  far  as  we  know  at  the  present  time,  only 
comes  from  previous  cases  of  the  disease.  Cleanliness 
not  only  lessens  the  danger  of  serious  complications  which 
are  often  fatal,  and  mitigates  the  severity  of  an  attach, 
but  it  is  the  great  germ-destroyer,  and  prevents  the  spread 
of  this  dread  disease  in  households. 


CHAPTER    XVII. 

MEASLES. 


How  it  is  contracted — How  the  Contagion  is  carried — Why  it  is 
the  most  contagious  of  the  Eruptive  Diseases— The  Peculiarity 
of  the  Eruption— The  Dangers  of  Pulmonary  Trouhles  as  Com- 
plications or  following  the  Disease — The  Nursing. 

There  are  so  many  matters  in  common  between 
scarlet  fever  and  measles,  that  it  will  be  unnecessary 
to  repeat.  Measles  is  a  disease  which  comes  from  a 
special  poison  of  its  own,  one  which  only  produces 
measles ;  this  poisonous  principle,  or  germ,  is  especially 


MEASLES.  187 

active  in  the  breath,  in  the  secretions  from  the  eyes 
and  nose,  and  the  whole  respiratory  tract ;  and  as  these 
secretions  are  very  much  more  active — in  fact  consti- 
tute a  marked  feature — in  this  disease,  the  child  with 
it  forms  a  focus  of  contagion  for  those  who  come  in 
contact  with  the  air  which  has  passed  over  the  surface 
of  its  mucous  membrane.  The  anointed  skin  in  scar- 
let fever,  the  absence  of  marked  catarrh  and  profuse 
secretion,  the  thorough  isolation  which  is  always 
insisted  upon,  probably  account  for  the  fact  that 
measles  seems  by  far  the  more  contagious  disease. 
There  is  another  peculiarity  which  also  accounts  for 
this :  the  catarrh  of  measles,  resembling  an  ordinary  cold 
in  the  head,  may  be  mistaken  for  such,  and  the  child 
for  the  few  days  preceding  the  rash  may  associate 
with  other  children,  and  thus  disseminate  the  elements 
of  contagion.  The  period  of  incubation  in  this  disease 
is  from  twelve  days  to  two  weeks,  but  of  course  dur- 
ing this  time,  unless  we  know  a  history  of  exposure, 
there  is  nothing  special  to  attract  our  attention.  The 
disease  usually  manifests  itself  by  all  the  symptoms  of 
a  violent  cold  in  the  head :  the  eyes  become  suffused, 
very  watery,  and  intolerant  of  light;  the  discharge 
from  the  nose  is  constant,  the  child's  face  puffy  and 
red,  apparently  swollen  ;  there  is  a  tendency  to  drowsi- 
ness. Of  course  there  is  fever,  the  child's  skin  is  hot 
and  dry,  and  the  little  sufferer  rolls  and  tosses  from  side 
to  side.  These  symptoms  are  not  very  marked  at  first, 
and  the  child  is  supposed  to  have  caught  cold ;  but 
they  increase  in  severity,  and  it  is  not  until  about  the 
fourth  day  when  the  rash  makes  its  appearance  upon 
the  face.  Previous  to  that,  however,  if  the  throat  be 
examined,  the  outline  of  a  rash  characteristic  of 
measles  can  be  determined  upon  it.  All  this  time 
the  child  suffers  with  paroxysms  of  a  dry,  ringing, 
croupy  cough ;  the  tongue  is  usually  slightly  coated, 
the  appetite  is  lost,  and  the  fever,  with  the  catarrh  of 


188  CHILDHOOD. 

the  mucous  membrane,  gives  rise  to  intense  thirst.  The 
first  appearance  of  the  rash  is  upon  the  temple,  the 
forehead,  the  neck,  extending  down  the  chest  and 
arms,  and  finally  covering  the  body.  The  word  rash 
is  a  misnomer  when  applied  to  the  eruption  of  measles, 
and  refers  more  especially  to  that  in  scarlet  fever. 
When  noticed  upon  the  forehead,  the  temple,  or  the 
neck,  it  seems  at  first  as  if  it  were  beneath  the  skin ; 
a  number  of  small  clusters  of  points,  resembling  flea- 
bites,  that  form  a  crescent  when  the  finger  is  passed 
over  the  surface ;  a  slight  elevation  is  noticed.  These 
elevations  increase  until  they  rise  distinctly  above  the  sur- 
face, and  form  a  papule.  As  soon  as  the  whole  surface 
of  the  body  becomes  covered  with  the  eruption,  the  skin 
is  decidedly  rough  and  papular  to  the  touch,  and  the 
crescentic  outline  of  the  papules  in  these  patches  over 
the  entire  surface  of  the  body  can  be  distinctly  noted. 
There  is  no  mistaking  a  case  of  measles  at  this  stage, 
or  confounding  it  with  scarlet  fever.  The  suffused 
eyes  intolerant  of  light,  with  swollen  eyelids,  the  puny 
face  covered  with  its  speckled  eruption,  the  excessive 
nasal  discharge  or  evidences  of  swelling  of  the  mucous 
membrane  of  the  nose,  the  croupy  cough,  which  is  con- 
stant and  annoying,  are  in  themselves  sufficiently  plain 
to  be  the  distinguishing  feature.  The  rash  after  three 
or  four  days  gradually  fades  from  the  surface,  leaving 
in  many  cases  a  slight  staining  of  the  skin  in  freckles 
or  spots,  disappearing  first  from  the  parts  first  affected. 
The  fever  gradually  subsides,  though  the  cough  and 
evidences  of  bronchitis  may  remain  for  some  time  longer. 
The  skin  will  not  come  oif  in  flakes,  as  is  usual  in 
cases  of  scarlet  fever,  especially  where  no  ointment  has 
been  used  ;  it  is  usually  shed  in  small  bran-like  scales. 
The  lungs  bear  the  brunt  of  this  disease  in  neglected 
or  severe  cases,  and  just  as  we  guard  the  kidneys  in 
scarlet  fever,  to  prevent  their  congestion,  so  in  this  dis- 
ease we  protect  the  lungs  from  the  very  first,  by  carefully 


MEASLES.  189 

guarding  against  draughts,  impressions  of  cold,  internal 
congestion,  by  endeavoring  to  establish  the  eruption 
over  the  whole  surface  of  the  body,  by  protecting  the 
eyes  from  light  and  the  skin  from  draughts.  Measles 
is  a  disease  which  is  very  fatal  among  the  poor,  much 
more  so  than  scarlet  fever ;  that  is,  in  the  earlier  stages, 
owing  to  the  fact  that  acute  diseases  of  the  lungs,  as 
congestion,  pneumonia,  kill  very  much  more  quickly 
than  the  diseases  of  the  heart  and  kidneys  that  follow 
scarlet  fever,  and  probably  do  not  show  themselves  for 
weeks  or  months  after  the  termination  of  the  disease. 
Croup  in  all  its  forms,  bronchitis,  congestion  of  the 
lungs,  pneumonia,  may  occur  in  the  earlier  stages  of 
measles  and  be  fatal,  through  exposures  to  draughts 
and  through  improper  nursing;  nor,  indeed,  is  a  child 
entirely  safe  until  all  evidences  of  catarrh  of  the  respir- 
atory organs  have  disappeared.  Taking  a  child  into 
the  cold  air  too  soon  may  bring  on  a  fatal  pneumonia ; 
exposure  to  sewer-gas  in  the  sleeping-room  may  produce 
a  fatal  diphtheritic  croup  ;  the  exposure  to  the  contagion 
of  whooping-cough  may  engraft  this  disease,  with  serious 
results ;  the  throwing  oif  the  bedclothes,  thus  chilling 
the  body,  may  congest  the  lung  or  eventually  aifect 
the  heart ;  then,  again,  indigestion  may  produce  an 
irritation  of  the  bowel,  and  a  serious  diarrhoea  follow. 
The  mucous  membrane  of  the  stomach  and  bowel  is 
affected  in  this  disease,  simultaneously  with  the  mucous 
membrane  of  the  respiratory  passages.  Although  vomit- 
ing is  not  as  apt  to  occur  as  an  initial  symptom  as  in 
scarlet  fever,  still  diarrhoea,  especially  in  the  heated 
term,  is  often  a  serious  complication,  probably  indicating 
inflammation  of  the  bowel,  and  should  be  carefully 
watched.  Not  alone  do  we  have  complications  of  so 
serious  a  nature  as  to  threaten  life,  but  in  scrofulous 
children,  or  those  who  are  simply  run  down,  loss  of  sight 
or  of  hearing  may  be  the  result  of  careless  nursing. 
The  same  general  principles  regarding  the  ventilation 


190  CHILDHOOD. 

of  the  sick-room,  cleanliness  of  the  body,  diet,  ought  to 
be  observed  in  the  nursing  of  measles  as  we  have  just 
laid  down  for  that  of  scarlet  fever,  possibly  slightly 
modified,  owing  to  the  difference  in  the  two  affections. 
Thus,  in  measles  the  tendency  to  pulmonary  congestion 
will  necessitate  keeping  the  feet  warm  to  promote  cir- 
culation, and  possibly  the  use  of  poultices  to  the  chest, 
or  of  cotton  or  some  non-conducting  substance.  A 
child  with  measles  should  be  guarded  as  carefully 
against  going  out  too  soon  as  in  scarlet  fever.  I  may 
once  more  impress  upon  mothers  the  fact  that  if  they 
have  a  dry,  well-ventilated,  sunny  nursery,  apart  from 
the  sleeping-room,  it  is  a  mistake  to  run  any  risk  in 
taking  a  child  out  of  doors  when  the  weather  is  the  least 
objectionable, — that  is,  on  days  that  are  damp,  raw,  and 
foggy,  or  when  the  winds  are  piercing.  I  insist  upon 
this,  not  only  for  children  who  are  convalescing  from 
disease,  but  even  for  children  who  are  perfectly  well ; 
there  would  be  fewer  catarrhs  and  sore  throats  if  this 
plan  were  more  generally  adopted.  Great  care  should 
be  taken,  when  a  sick  child  has  a  movement  from  its 
bowels  or  bladder,  that  it  is  well  covered  and  protected 
from  draughts. 

I  need  not  repeat  all  that  has  been  said  when  speak- 
ing of  scarlet  fever,  in  regard  to  the  diet  and  home 
treatment;  the  mildest  form  of  nourishment  should 
be  given, — milk,  diluted  with  an  alkali,  given  at  fre- 
quent intervals,  also  chicken-tea,  egg  albumen  in  water, 
beef  essence  or  juice,  with  cracked  ice,  toast- water  and 
wine-whey,  or  wine-whey  and  barley-water.  No  solid 
diet  should  ever  be  given  in  fevers.  The  child  should  be 
allowed  to  drink  water  freely,  but  in  small  quantities  at  a 
time.  Glycerin  and  water,  the  proportion  being  a  tea- 
spoonful  in  half  a  tumbler  of  water,  will  often  relieve  the 
dryness  of  the  mouth  and  throat,  at  the  same  time  allaying 
thirst.  Weak  lemonade  sweetened  with  a  little  glycerin, 
not  immediately  after  milk,  is  most  refreshing  in  fevers. 


SECOND  DENTITION.  191 

Sweet  spirits  of  nitre,  a  teaspoonful  to  a  tumbler  of 
water,  will  quiet  the  nervous  system,  if  the  child  drinks 
frequently  of  it  during  the  night,  and  is  likely  to  pro- 
mote sleep.  A  hot  foot-bath  is  always  efficacious,  if 
the  feet  are  kept  warm  afterwards.  A  teaspoonful  of 
spirits  of  Mindererus,  with  a  teaspoonful  of  sweet  spirits 
of  nitre  in  a  half-tumbler  of  water,  forms  a  household 
fever-mixture  which  can  be  safely  sipped  by  a  child  from 
time  to  time  until  the  doctor  arrives.  Anointing  the 
body  as  in  scarlet  fever,  with  carbolated  vaseline  or  cold 
cream,  allays  irritability  even  from  the  onset  of  the 
eruption.  The  room  should  be  darkened,  as  the  eyes 
are  weak. 


CHAPTER    XVIII. 

SECOND  DENTITION. 

Forcing  in  Education  to  be  Condemned — What  is  Meant  by  Second 
Dentition — Complications  Due  to  Hereditary  or  Acquired  Con- 
ditions— Eickets — How  it  is  to  be  Avoided — Diet  of  Children 
at  this  Age — Clothing. 

This  work  would  be  incomplete  were  we  simply  to 
devote  our  attention  to  that  time  which  is  limited  to  the 
cutting  of  the  milk-teeth.  There  are  various  disorders 
of  childhood  that  are  dependent  more  or  less  upon  the 
disturbance  of  the  equilibrium  that  should  be  maintained 
between  growth  and  development.  This  disturbance 
is  usually  brought  about  by  the  unnatural  pressure 
which  fashion  or  habit  exerts  upon  the  growing  tissues 
of  the  child,  by  brain-forcing  and  muscle-cramping,  by 
the  want  of  that  freedom  and  abandonment  which  gives 
food  for  the  muscles'  growth  and  carries  away  the 
ashes  of  their  destruction,  and  the  pernicious  system  of 
over-education,  that  endeavors  to  place  an  adult  brain 
in  a  child's  body.     Indeed,  it  is  this  attempt  at  forcing 


192  CHILDHOOD. 

that  is  productive  of  the  many  disorders  which  attend 
the  period  of  permanent  dentition. 

It  is  not  the  cultivation  of  the  mind  that  physicians 
object  to,  but  it  is  the  system  by  which  it  is  often  accom- 
plished that  is  radically  wrong. 

After  a  child  has  passed  its  first  dentition,  there  is 
little  to  call  our  attention,  barring  the  accidents  that 
may  arise  from  contagious  diseases.  About  the  sixth 
year  it  will  cut  the  four  first  molars ;  about  its  twelfth 
year  it  will  cut  the  four  second  molars  ;  and  after  the 
eighteenth  year  the  so-called  wisdom-teeth.  These  teeth 
are  all  new  ones.  The  jaw  has  to  change  in  shape  and 
size  to  accommodate  them  as  they  grow ;  they  produce 
a  certain  amount  of  pressure  upon  the  nerve-pulp  at 
their  base,  and  give  rise  to  neuralgia  and  reflex  dis- 
turbances, produce  irritation  of  the  mouth,  the  throat, 
consequent  disorders  of  the  tonsils,  ear-troubles,  and, 
possibly,  disorders  of  the  intestinal  canal,  interference 
with  digestion,  with  blood-making,  and,  possibly,  as  a 
consequence,  many  of  those  peculiar  hysterical  phenom- 
ena that  attend  puberty,  both  in  boys  and  girls,  but 
especially  girls.  In  fact,  a  child's  brain  that  is  excited 
by  over-study,  over-stimulated,  in  other  words  congested, 
and  by  blood  that  is  not  of  the  purest,  owing  to  deficient 
exercise  and  under-feeding,  falls  a  ready  victim  to  the 
slightest  pressure  or  irritation  that  will  result  from  the 
growth  of  one  of  these  permanent  teeth.  The  other 
sets  of  permanent  teeth,  that  are  cut  from  the  sixth  to 
the  fourteenth  year,  simply  take  the  place  of  milk-teeth, 
and,  consequently,  do  not  produce  the  same  degree  of 
irritation ;  it  is,  indeed,  a  difficult  matter  to  decide  in  an 
individual  case  exactly  how  much  disturbance  is  due  to 
teething,  and  how  much  to  the  general  impairment  of 
nutrition  which  results  from  the  child's  surroundings 
and  mode  of  life. 

A  strong,  healthy  child,  brought  up  in  the  country, 
rarely  has  any  difficulty  at  this  time. 


SECOND  DENTITION.  193 

The  general  impairment  of  nutrition,  which  is  fol- 
lowed by  debility,  languor,  all  resulting  from  the  loss 
of,  or  perverted,  appetite,  and  defective  secretions,  are 
the  most  frequent  disturbances  that  we  meet  with  dur- 
ing second  dentition.  We  have  at  this  time,  also,  dis- 
turbance of -the  mucous  membrane  of  the  mouth,  of 
the  gums,  due  to  the  irritation  of  the  milk-teeth,  whose 
roots  become  absorbed ;  possibly,  want  of  cleanliness 
may  lead  to  incrustations  or  spongy  condition  of  the 
gum,  with  pressure  and  ulceration.  Also  enlargement 
of  the  tonsils,  with  various  forms  of  inflammation,  are 
very  apt  to  occur  at  this  time ;  especially  that  variety 
which  is  attended  by  a  grayish  deposit,  very  readily 
mistaken  for  diphtheria,  and  to  which  the  physician's 
attention  should  be  immediately  called.  We  also  have 
a  tendency  to  chronic  enlargement  of  the  tonsil,  which 
will  give  rise  to  earache,  sometimes  difficulty  in  swal- 
lowing, snoring  at  night,  with  restlessness,  and  a  ten- 
dency to  acute  inflammation  or  quinsy  upon  the  least 
exposure  to  cold. 

Such  children  are  prone  to  have  attacks  of  neural- 
gia, headache,  toothache,  or  neuralgia  of  the  face; 
their  tongues  are  apt  to  be  coated ;  they  have  frequent 
bilious  attacks.  It  is  also  at  this  time  that  what  is 
known  as  scrofula  is  apt  to  develop,  enlargement  of 
the  glands  of  the  neck,  weak  eyes,  nasal  catarrh  show 
themselves ;  all  these  conditions,  although  occurring  at 
the  same  time  as  the  second  dentition,  are  by  no  means 
dependent  upon  it  in  all  cases ;  they  are  attendant 
upon  excessive  growth  and  faulty  development,  mal- 
nutrition, inherited  taints.  During  this  time  also  occur 
frequently  those  deformities  which  are  the  result  of 
improper  deposit  of  lime  in  the  bone,  or  the  reabsorp- 
tion  of  bone  from  pressure  due  to  all  sorts  of  mechan- 
ical causes ;  among  these  we  find  the  diseases  of  the 
joints,  curvatures  of  the  spine,  and  also  the  imperfect 
formation  of  the  permanent  teeth,  which  renders  them 
i       »  17 


194  CHILDHOOD. 

brittle  or  soft,  readily  broken,  or  easily  affected  by  the 
acid  eructations  that  come  from  a  disordered  stomach, 
— a  mere  shell  of  a  tooth,  as  it  were,  which  soon  be- 
comes carious,  and  unfortunately  cannot  be  replaced. 

We  see,  then,  that  the  mother's  attention  should  be 
called  to  her  rapidly-growing  child,  in  order  to  perfect 
its  development  in  such  a  way  that  its  tissues  will  be 
well  formed  and  nourished,  its  functions  established,' 
by  the  time  it  reaches  maturity.  There  are  certain 
other  disturbances  which  occur  during  second  denti- 
tion that  require  our  attention ;  there  are  frequent  bil- 
ious attacks,  or  certain  fevers  apparently  due  to  growth, 
that  come  on  without  any  appreciable  cause.  A  child 
will  have  a  slightly  furred  tongue,  will  complain  of 
pain  in  its  bones,  of  languor,  loss  of  appetite,  will  be 
restless  in  its  sleep,  will  suffer  from  headache,  which  is 
usually  frontal.  Suddenly  it  will  develop  a  high  fever, 
the  face  will  be  flushed,  the  eyes  red,  and  indeed  if 
vomiting  occurs,  and  the  child  has  not  previously  had 
the  disease,  we  might  almost  expect  the  onset  of  scarlet 
fever.  The  child  should  have  a  hot  mustard  foot-bath, 
should  be  given  sweet  spirits  of  nitre  in  its  water  to 
drink  ;  if  the  tongue  is  coated,  it  should  be  given  a  dose 
of  either  Murray's  or  Phillips's  fluid  magnesia,  or  a 
dose  of  castor  oil,  and  the  chances  are  the  next  morning 
the  child  will  awake,  bright  and  cheerful,  without  any 
bad  results  from  its  attack. 

Rheumatism  is  very  common  at  this  period  of  life ; 
indeed,  many  of  the  cases  of  so-called  growing-pains 
are  nothing  more  or  less  than  masked  rheumatism. 
If  a  child  complains  constantly  of  aching  in  its  limbs, 
seems  loth  to  take  exercise,  the  attention  of  the  doctor 
should  be  called  to  its  condition. 

Elsewhere  I  have  written  of  the  care  of  infants 
during  the  period  which  terminates  at  about  the  age  of 
five  years.  There  is  not  much  to  call  our  attention  be- 
fore this  time  to  any  difference  between  the  sexes ;  the 


SECOND  DENTITION.  195 

girls  are  usually  more  delicate,  the  boys  hardier ;  the  girls 
having  more  tender  skins,  more  liable  to  eruptions. 
Boys  are  more  difficult  to  bring  up,  owing  to  the 
fierceness  with  which  they  are  attacked  by  infantile 
complaints.  Usually  the  difference  in  sex  makes  itself 
manifest  in  temperament  as  soon  as  the  infant  becomes 
sufficiently  independent  to  amuse  itself,  and  especially 
is  this  the  case  with  the  first-born,  who  has  no  one  to 
copy,  no  playmate  older  than  itself  by  whom  it  can  be 
led.  Even  at  this  early  age  parents  should  as  much 
as  possible  endeavor  to  train  a  child  to  enjoy  out-door 
amusements,  to  give  it  exercise,  that  it  may  grow 
hardy,  graceful,  and  cheerful  in  disposition.  This  will 
have  to  be  encouraged  in  the  girls ;  the  boys  take  to  it 
as  ducks  take  to  water. 

It  is  in  these  tender  years,  when  the  bones  are  yet 
frail  and  soft,  that  those  deformities  which  become  the 
source  of  so  much  disease  in  later  life  develop  them- 
selves. People  are  apt  to  imagine  that  rickets  and 
scrofula  are  confined  chiefly  to  the  lower  classes,  to 
the  poor.  This  is  a  great  mistake ;  they  enter  every 
household  where  the  conditions  which  favor  their  de- 
velopment are  found. 

Let  us  dwell  for  a  few  moments  upon  this  matter  of 
importance  in  infant  life.  All  the  long  bones  of  the 
body  are  composed  of  three  parts ;  the  two  ends  which 
come  in  contact  with  the  same  part  of  other  bones, 
and  form  the  joints  and  then  the  shaft.  In  later  years 
these  ends  become  united  to  the  shaft,  and  the  whole 
becomes  one  solid  bone.  Bones  are  composed  of  two 
kinds  of  material :  the  gelatinous,  which  gives  pliability 
and  elasticity  to  them,  and  the  mineral,  which  makes 
them  firm  and  strong.  Of  the  latter,  the  salts  of  lime 
form  the  most  important  part. 

In  infant  life  the  growing  bone  receives  an  immense 
amount  of  nourishment ;  it  grows  rapidly.  The  centre 
is  spongy,  and  filled  with  blood-channels.     The  bones 


196  CHILDHOOD. 

are  by  no  means  hard  at  this  age,  and  should  any- 
thing diminish  the  amount  of  lime  they  receive,  the 
movements  of  the  child,  the  straining  of  its  muscles, 
the  weight  of  its  body,  would  cause  the  bones  to  curve, 
and  unless  attention  is  immediately  given,  this  curving 
will  be  permanent.  Especially  is  this  the  case  where 
the  bony  shaft  is  attached  to  the  cartilage  to  form  a 
joint ;  naturally,  the  rapid  growth  requires  such  joints 
to  be  loose  and  yielding  and  elastic,  and  the  constant 
strain  will  so  stretch  them  as  to  produce  deformity. 

A  young  child  who,  instead  of  running  out  in  the 
fields,  or  gayly  skipping  up  the  street,  filling  its  lungs 
to  the  utmost  and  sending  ample  nourishment  to  every 
tissue  of  its  body,  sits  by  the  hour  by  its  mother's  side 
nursing  her  doll,  though  an  object  of  beauty  is  a  melan- 
choly one,  as  time  will  show  that  nature's  laws  are 
being  interfered  with.  We  know  that  there  is  a  pressure 
of  fifteen  pounds  to  every  square  inch  of  surface  on  all 
bodies  at  the  level  of  the  sea.  In  breathing,  a  certain 
amount  of  force  is  required  to  overcome  this.  In  a 
frail,  delicate  child,  whose  muscles  are  imperfectly 
developed,  the  lungs  are  scarcely  ever  inflated  to  their 
fullest  extent,  the  constant  atmospheric  pressure  not 
overcome  will  tend  to  flatten  the  chest-walls,  and  when 
the  bones  are  hardened  the  breast-bones  assume  the 
form  known  as  pigeon-breasted ;  one  of  the  great  pre- 
dispositions to  consumption  will  be  introduced. 

A  child  that  is  made  constantly  to  breathe  fully  and 
deeply  by  out-door  exercise,  and  at  the  same  time  has  its 
chest  freed  from  all  restraints  of  close-fitting  garments 
or  the  injurious  requirements  of  fashion,  will  bless  its 
parents  in  the  future  for  the  great  gift  of  health,  which 
is  an  heirloom  of  priceless  value.  The  girls  as  well  as 
the  boys  should  be  straight-limbed  and  full-chested. 

The  disease  called  rachitis  or  rickets  is  brought 
about  not  only  in  those  children  whose  parents  live  in 
damp,  ill-ventilated  dwellings,  devoid  of  all  the  com- 


SECOND  DENTITION.  197 

forts  of  life,  exposed  to  the  intense  cold  of  winter  and 
the  great  heats  and  atmospheric  impurities  of  summer  ; 
it  is  also  noticed  among  the  rich,  who,  possessing  every 
comfort  in  life,  may  either  through  ignorance  or  care- 
lessness fail  to  supply  food  which  nature  has  intended  to 
make  bones  firm  and  muscles  strong,  or  they  neglect  to 
see  that  their  children  are  kept  in  a  proper  state  of 
health  to  digest  and  assimilate  such  food. 

Fashionable  mothers  are  only  too  desirous  of  trans- 
ferring their  duties  to  an  experienced  nurse,  and  con- 
sider the  task  which  was  intended  by  heaven  as  a  sacred 
duty  complete  when  they  have  purchased  the  most  fash- 
ionable baby-carriage  and  a  full  supply  of  condensed 
milk.  Experiment  has  shown  that  the  strongest  ani- 
mals can  be  made  rickety  by  the  character  of  the  food 
with  which  they  are  fed,  and  experience  shows  that 
children  who  show  a  tendency  to  rickets,  if  fed  upon 
nutritious  food  and  given  plenty  of  fresh  air  and  exer- 
cise, can  be  made  strong,  and  outgrow  the  predisposi- 
tion. It  is  on  this  account  that  so  much  stress  is  laid 
upon  the  use  of  the  various  cereals  in  the  feeding  of 
growing  children,  especially  oatmeal  and  cracked  wheat. 
Every  child  at  the  age  I  am  now  speaking  of,  that  is 
after  the  completion  of  its  first  dentition,  should  be  given 
its  three  regular  meals  a  day  :  the  breakfast  consisting 
of  bread  and  butter,  a  plate  of  well-cooked  oatmeal  with 
cream  and  plenty  of  milk,  a  soft-boiled  egg,  a  mutton- 
chop,  or  a  piece  of  steak  finely  cut  up.  Avoid  hot 
cakes,  very  fresh  bread,  or  rich  dishes  of  any  sort. 
For  the  dinner,  which  should  invariably  be  at  an  early 
hour,  it  is  an  important  matter  when  possible  to  give 
fresh  vegetables, — well-cooked  potatoes  and  rice,  prop- 
erly boiled,  and  encourage  them  to  eat  bread  with  their 
meals.  They  should  also  have  either  cooked  fruits  or 
ripe,  raw  fruits  in  abundance.  The  final  meal  should 
be  varied ;  meat  should  be  avoided  ;  soft  custards,  milk 
toast,  or  bread  and  butter  made  more  inviting  by  a 

17* 


198  CHILDHOOD. 

little  good  preserve.  An  outline  of  this  sort  will  give 
an  idea  of  the  character  of  food  that  supplies  brain, 
muscle,  and  nerve.  It  may  be  modified  according  to 
the  peculiarities  of  the  child,  the  time  of  the  year,  and 
the  family  circumstances. 

Do  not  let  a  mother  suppose  that  because  she  has 
nursed  her  infant  the  usual  time  it  cannot  become  rick- 
ety. Unless  she  lives  upon  food  which  will  give  to 
her  milk  in  full  proportion  the  quantities  represented 
in  the  diet  mentioned  above,  her  child,  though  nursed 
and  to  all  outward  appearances  subjected  to  only  what 
would  be  best  for  it,  will  in  reality  be  no  better  off  than 
a  bottle-fed  baby;  indeed,  a  child  carefully  brought 
up  on  the  bottle  by  one  experienced  should  be  healthy 
in  all  respects. 

I  think  that  most  mothers  forget  this  important 
point,  that  the  nourishing  quality  of  their  milk  de- 
pends on  their  own  state  of  health. 

As  far  as  the  medical  treatment  of  rickets  is  con- 
cerned, we  may  only  mention  here  those  drugs  which 
are  in  reality  other  forms  of  food.  Cod-liver  oil 
is  pre-eminently  the  most  important.  It  may  have 
been  ordered  by  the  physician  in  early  infant  life,  but 
if  at  the  period  of  childhood  of  which  we  are  now 
speaking,  no  physician  is  at  hand,  a  mother  should 
not  hesitate  to  give  it  should  the  child  complain  of  fa- 
tigue, grow  thin,  lose  its  appetite,  or  show  other  evi- 
dences of  bad  nutrition. 

Before  concluding  this  chapter  it  may  be  well  to 
make  a  few  remarks  regarding  the  dress  of  young 
children.  Habits  of  regularity  should  be  instilled 
from  the  very  earliest  opportunity,  and  may  be  so  well 
established  that  by  the  second  year  the  diaper  can 
be  exchanged  for  drawers.  Should  summer  make  it 
convenient  to  do  so  at  an  earlier  period,  it  may  be  well 
to  make  the  change,  as  in  some  children  the  thick  fold- 
ing  of  the  diaper  is  very  apt  to  make  them  bow-legged, 


SECOND  DENTITION.  199 

especially  if  it  is  not  very  carefully  put  on.  This  of 
course  only  refers  to  children  who  are  walking.  As 
regards  the  clothing  of  children  in  our  damp  seaboard 
climate,  flannel  should  be  insisted  upon  all  the  year 
round. 

For  teething  children  fine  merino  stockings  should 
be  worn  all  the  year.  The  important  things  to  bear  in 
mind  are  the  simplicity  and  loose  fitting  of  all  their 
clothing;  the  latter  is  most  essential  for  growing 
children,  as  deformity,  stooping  shoulders,  contracted 
chest,  and  weakened  backs  depend  a  great  deal  upon 
ill-fitting  garments.  Would  that  mothers  were  suffi- 
ciently impressed  with  this  fact ! 

The  next  thing  is  the  proper  change  of  clothing  to 
suit  the  seasons.  Warm  clothing  is  not  necessarily 
cumbersome,  and  merino  undershirts  with  high  necks 
are  certainly  important  even  in  summer,  though  they 
be  of  the  thinnest  kind.  I  do  not  think  that  croup 
is  nearly  as  prevalent  as  it  used  to  be,  and  I  can  but 
attribute  this  to  the  much  more  common-sense  way 
of  clothing  children  than  was  fashionable  some  years 
ago ;  the  bare-necked,  bare-armed,  and  bare-legged 
babies  in  mid-winter  are  no  longer  seen, — the  frail 
flowers  of  our  hot  winter  houses,  to  be  the  victims  of 
draughts  which  are  so  fatal. 

All  children  should  wear  thick-soled  shoes,  easy  and 
well  fitting,  with  room  for  growth  at  the  toes ;  they 
should  not  have  heels. 

The  importance  of  light  calisthenics  at  this  age  can- 
not be  over-estimated.  Not  only  do  they  give,  under 
competent  management,  a  graceful  and  easy  carriage, 
which  means  symmetrical  development,  but  they  give 
muscular  power,  increase  the  force  of  the  circulation, 
develop  the  chest  and  thereby  the  activity  of  the  lungs, 
give  tone  to  the  nervous  system,  and  in  other  words 
improve  the  digestion  and  the  appetite,  and  in  that  way 
secure  a  flow  of  good,  nourishing  blood. 


200  CHILDHOOD. 

CHAPTER    XIX. 

PUBEKTY. 

Puberty — The  Pour  Second  Molars — The  tendency  to  Disturbance 
of  Digestion  at  this  Time — The  Importance  of  Proper  Pood  and 
Clothing,  also  Preedom  from  Excitement  and  the  use  of  Iron — 
Pirst  Menstruation — Menstrual  Irregularities — Hysteria — Dys- 
menorrhoea — The  Abuse  of  Anodynes — The  Mother  the  proper 
Confidant  of  her  Daughter. 

We  will  devote  a  few  moments  to  the  consideration 
of  the  changes  which  take  place  in  girls  at  puberty : 
partly  from  the  fact  that  at  this  time  we  are  still  within 
the  period  of  the  second  or  permanent  dentition.  In- 
deed, it  will  be  noticed  that  at  the  very  age  when  men- 
struation first  shows  itself,  the  girl  is  susceptible  to  all 
those  functional  disturbances  that  may  be  brought  about 
by  the  cutting  of  the  four  second  molars,  a  set  of  teeth  that 
are  developed  anew,  not  replacing  any  of  the  milk-teeth. 
No  wonder,  then,  that  it  is  most  important  that  the 
young  girl  should  be  under  the  care  of  a  mother  prop- 
erly instructed  to  guide  her  and  guard  her  during  this 
time.  The  natural  impulse  of  her  sex  is  towards  sed- 
entary occupation,  seclusion,  long  dresses,  and  possibly 
her  first  real  novel, — all  of  these  in  themselves  perni- 
cious; they  weaken  her  muscles,  lessen  her  appetite, 
tend  to  constipation,  excite  her  brain. 

It  is  scarcely  necessary  to  mention  the  boys  at  this 
age.  The  out-door  life  that  they  lead,  especially  at  the 
present  time,  when  there  is  so  much  for  a  boy  to  do, 
tends  to  keep  them  in  good  physical  condition,  and 
renders  them  insusceptible  to  the  many  reflex  disturb- 
ances which  might  exist.  I  may  quote  from  a  paper 
that  I  recently  wrote  upon  this  subject : 1 

We  all  recognize  the  very  great  importance  of  all 

1  Published  in  the  Medical  and  Surgical  Reporter,  Oct.  23, 1886, 


PUBERTY.  201 

that  tends  towards  muscular  development  in  growing 
girls.  They  should  be  symmetrically  developed,  should 
have  full  chests,  straight  backs,  and  strong  limbs.  We 
should  also  urge  the  importance  of  clothing  of  light 
weight  and  loose  fitting,  the  principal  strain  being  on 
the  shoulders,  not  on  the  waist  and  hips,  and  also  the 
evil  results  of  cramped,  stooped  positions  in  the  school- 
room, eye-strain,  and  bad  ventilation.  We  all  urge 
these  matters  daily,  and  we  know  how  little  attention 
is  paid  to  them.  But  there  are  certain  forms  of 
various  disorders  which  occur  about  the  time  of  the 
second  dentition  which  deserve  more  than  a  passing 
notice.  These  are  manifested  either  as  a  chorea  (St. 
Vitus'  Dance),  nervous  excitement  such  as  night  ter- 
rors, and  various  mental  disturbances  (misnamed  hyste- 
ria), gastro-intestinal  disorders,  and  evidences  of  mal- 
nutrition. The  child  will  probably  become  languid, 
suffer  with  frontal  headache,  become  peculiar  in  her 
disposition  and  show  fits  of  temper,  shun  society  of 
other  children,  lose  her  appetite,  become  despondent, 
and  possibly  develop  a  local  twitching  of  some  of  the 
facial  muscles.  It  is  customary  to  say  that  this  is  all 
reflex,1  is  possibly  the  warning  that  the  system  is 
undergoing  some  change  preparatory  to  the  menstrual 
functions, — that  it  is,  in  fact,  a  true  hysteria.  This 
may  or  may  not  be  the  case.  My  own  impression  is 
that  it  is  often  due  to  the  anaemia  (impoverished  blood) 
brought  about  by  rapid  growth  and  development,  with 
faulty  assimilation  and  deficient  oxygenation.  In  my 
experience  such  cases  present  two  types,  the  one  essen- 
tially nervous,  just  described,  the  other  the  so-called 


1  Sufficient  attention  has  not  been  called  to  the  disturbances 
caused  by  the  pressure  of  the  twelfth-year  molars.  These  may 
show  themselves  in  either  dental  neuralgia,  or,  in  fact,  any  form 
of  trifacial  neuralgia,  gastric  disorders,  or  mental  peculiarities, 
amounting  to  melancholia  or  symptoms  of  acute  meningeal  irri- 
taticn. 


202  CHILDHOOD. 

strumous  or  lymphatic,  in  whom  the  want  of  proper 
assimilation  is  shown  by  a  large  amount  of  stored  fat, 
and  the  aneemia  by  excessive  pallor  (called  chlorosis). 

The  nervous  system  seems  to  run  riot,  but  this 
very  excitement  in  itself  is  an  evidence  of  the  de- 
mand on  the  part  of  nature  for  a  blood-supply  which 
is  nutritious  and  well  oxygenated.  All  the  exercise  in 
the  world,  all  the  most  nutritious  and  sustaining  of 
foods,  will  have  no  effect,  until  the  digestive  organs  are 
made  to  perform  their  normal  functions.  If  you  ex- 
amine the  tongue  you  will  find  it  coated ;  the  breath  is 
heavy,  the  bowels  are  sluggish,  the  appetite  is  per- 
verted, the  child  craves  extraordinary  articles  of  food, 
especially  acids  and  sweets.  She  has  a  disgust  for  her 
regular  meals.  There  is  flatulence,  cardiac  palpita- 
tions, often  asthma  after  exertion.  The  urine  is  either 
scanty  and  high-colored,  or  very  copious  and  light. 
If  the  menses  have  been  established  they  are  scanty, 
colorless,  and  irregular,  or  there  is  a  leucorrhoea.  In 
these  cases  the  recommendations  of  popular  writers  for 
gymnastics,  friction,  milk  diet,  etc.,  are  admirable  after 
the  digestive  organs  have  been  cleared  of  their  accumu- 
lation, and  the  normal  functions  whipped  into  activity. 

As  far  as  the  general  treatment  is  concerned,  the 
patient  should  be  sponged  every  morning  with  tepid 
water ;  she  should  stand  in  a  tub,  and  have  a  pitcher 
of  it  poured  down  her  spine  from  the  nape  of  her  neck, 
and  then  be  thoroughly  rubbed  with  a  soft  Turkish 
towel  into  a  glow.  The  breakfast  should  consist  of 
warm  milk,  or  cocoa,  a  soft-boiled  egg,  a  rare  steak 
or  chop,  either  oatmeal,  cracked  wheat,  grits,  or 
Indian  meal  alternating ;  bread  and  butter,  not  hot 
cakes.  For  dinner,  soup,  rare  meat,  fresh  vegetables, 
ripe  or  stewed  fruits.  For  supper,  stewed  fruits, 
bread  and  butter,  warm  milk  or  cocoa,  neither  tea  nor 
coffee.  She  should  retire  early,  and  not  be  permitted 
to  read  at  night.     The  supply  of  oxygen  should  come 


PUBERTY.  203 

from  oat-door  exercise,  not  an  over-indulgence  in 
walks  or  games  that  fatigue ;  let  the  school  hours  be 
limited  to  the  early  part  of  the  day,  and  avoid  that 
abomination  of  preparing  lessons  in  the  afternoon  or 
evening  for  next  day's  recitations. 

Moderate  calisthenics,  or  massage,  should  be  daily 
given.  In  about  a  week's  time  the  girl  will  be  able  to 
bear  iron  alone,  and  the  tincture  of  the  chloride  can 
be  given  in  ten-  or  fifteen-drop  doses  for  some  time,  or 
a  chalybeate  water  can  be  given  with  arsenic.  The  di- 
gestive organs  will  now  also  tolerate  milk  in  large  quan- 
tities, provided  it  is  of  medium  richness,  is  fresh,  and 
given  warm. 

But  this  is  not  all.  There  are  very  many  cases  of 
a  highly  nervous  type  which,  despite  the  most  careful 
treatment,  will  not  improve  at  home.  The  constant 
association  with  parents  of  like  temperament,  however 
solicitous  they  may  be  in  carrying  out  instructions,  is 
of  itself  a  cause  of  nervous  irritation. 

It  may  be  necessary  to  send  such  children  from 
home,  either  to  some  relative,  living  possibly  in  the 
country  or  some  distant  city,  or  perhaps  to  some  sub- 
urban or  country  boarding-school,  where  a  thorough 
change  of  air  and  scene,  the  association  with  girls  of  a 
different  temperament,  will  work  wonders. 

For  the  strumous  type,  the  same  preparatory  treat- 
ment may  be  instituted,  and  for  such  I  would  not  hesi- 
tate to  push  the  iron,  phosphates,  cod-liver  oil  as  soon 
as  possible.  Change  of  air  to  the  sea-shore  is  advisable. 
There  is  little  trouble  in  the  home-treatment  of  these 
latter  cases ;  there  is  rarely  a  conflict  of  authority  in 
such  families. 

The  age  at  which  menstruation  appears  cannot  of 
course  be  definitely  stated,  so  much  depends  upon  cli- 
mate, race,  social  position,  and  family  peculiarities. 
Ordinarily,  about  the  age  of  fourteen  may  be  taken 
as  the  average  in  the  temperate  climate.     Of  course 


204  CHILDHOOD. 

whatever  tends  to  early  development,  such  as  warm 
climate,  in-door  occupation,  and  especially  among  those 
whose  occupation  is  sedentary  or  where  it  is  attended 
with  much  mental  excitement  pertaining  to  literary 
pursuits  or  the  excitement  from  the  whirl  of  society 
life  at  too  early  an  age,  will  bring  about  an  early  ap- 
pearance; whereas  the  contrary  will  have  a  retarding 
effect. 

There  are  cases  on  record  which  are  remarkable  for 
the  early  age  at  which  menstruation  was  established ; 
one  I  may  quote  from  Reinvillier,  who  records  a  case 
reported  by  Dr.  Beau,  of  New  Orleans,  of  a  girl  who 
at  birth  was  as  much  developed  as  a  girl  of  fourteen 
years.  At  the  age  of  three  years  her  period  came  on 
and  continued  naturally  every  month,  lasting  each 
month  three  days.  Such  cases  are  of  course  very  un- 
usual. 

The  period  at  which  this  change  to  puberty  takes 
place  is  marked  by  a  series  of  changes  which  show 
the  revolution  undergone  by  the  system.  For  some 
time  previous  the  nervous  system  has  felt  the  change  , 
the  temper  becomes  variable,  at  times  uncertain.  A 
girl  who  before  was  probably  gay  and  boisterous  in 
her  deportment  becomes  timid  and  shy,  easily  em- 
barrassed, the  slightest  cause  making  her  blush,  the 
knowledge  of  which  may  add  to  her  embarrassment. 
She  may  notice  a  gradually  increasing  development  of 
her  figure,  which  annoys  her  and  makes  her  shun  com- 
pany. Her  younger  companions  no  longer  have  the 
same  charm ;  involuntarily  she  prefers  the  society  and 
dress  of  those  older  than  herself.  The  watchful  mother 
at  once  recognizes  the  cause  which  is  bringing  about 
these  changes,  and  it  is  her  duty  to  gain  the  confi- 
dence of  her  child  and,  without  exciting  her  suspicions 
or  disturbing  her  already  uncertain  nervous  system, 
lead  her  to  understand  that  she  is  no  longer  a  child. 
She  is  a  woman,  and  it  falls  to  the  lot  of  all  women 


PUBERTY.  205 

who  are  in  good  health  to  have  a  certain  monthly 
drain  upon  their  system  which  is  calculated  to  relieve 
the  other  organs  of  the  body ;  and  should  it  appear  at 
any  time,  which  it  is  now  likely  to  do,  she  should  avoid 
all  things  that  might  check  it,  take  certain  precau- 
tions, as  rest,  etc.,  to  secure  its  regular  return,  which 
should  be  painless.  As  this  often  in  many  cases  comes 
unawares,  certain  precautions  in  clothing  have  to  be 
taken ;  especially  is  this  the  case  if  the  child  should 
happen  to  be  away  from  home  at  this  time.  Then 
again  it  is  well  for  them  to  learn  that  the  menstrual 
flow  may  at  times,  especially  in  delicate  girls,  be  at- 
tended by  severe  pain,  by  nervous  prostration,  in  fact 
by  a  constitutional  thunder-storm.  There  may  be  se- 
vere headache  (frequent  in  such  cases),  colic, — this 
latter  may  be  extremely  severe ;  there  may  be  giddi- 
ness, nausea,  extreme  nervousness,  chills  or  creeps,  ex- 
cessive backache,  all  of  which  may  come  on  suddenly, 
following  some  slight  indiscretion  in  diet  which  tends 
to  mislead  the  person  from  its  true  cause. 

When  a  young  girl  once  distinctly  understands  that 
the  object  of  her  monthly  flow  is  to  keep  her  in  good 
health, — and  this  surely  is  the  light  in  which  it  should 
be  presented  to  her, — she  will  readily  understand  that 
to  secure  the  health  which  is  heaven's  greatest  blessing 
she  must  be  strictly  guarded  as  to  the  care  of  herself. 
She  should  understand  that  after  one  appearance  the 
periodicity  of  this  function  is  not  at  once  established ; 
there  is  frequently  great  irregularity  in  its  return.  It 
may  last  but  a  few  hours  and  then  return  in  fifteen 
days ;  it  may  be  copious  at  first  and  then  not  return 
for  two  months  or  more.  Instead  of  appearing  as  it 
should  at  the  time  of  its  expectation,  it  may  appear  as 
a  bleeding  from  the  nose,  it  may  be  replaced  by  a  diar- 
rhoea, or  by  a  discharge  devoid  of  color. 

There  are  certain  signs  which  note  the  advance  of  a 
period,  and  it  is  well  for  the  mother  to  impress  upon 

18 


206  CHILDHOOD. 

her  daughter  to  be  careful  of  them.  Although  the 
normal  return  of  the  period  is  calculated  by  the  lunar 
month,  really  the  idea  that  the  moon  exerts  an  influ- 
ence upon  this  condition  has  no  basis;  this  is  shown 
by  the  fact  that  the  day  of  return  differs  in  women. 
Again,  some  have  the  normal  return  every  thirty,  others 
every  twenty-five  or  twenty-eight  days.  The  duration 
of  the  period  also  differs  in  most  women,  some. lasting 
three  or  four  days,  others  eight  or  more.  The  quantity 
also  differs ;  the  range  comprised  within  the  area  of 
health  is  widely  spread.  These  facts  are  important  to 
bear  in  mind  ;  though  should  any  deviation  exist  from 
that  which  the  mother  believes  to  be  the  normal  con- 
dition, she  should  mention  the  fact  to  the  family  phy- 
sician, and  let  him  be  the  judge  of  its  importance. 

During  this  period  of  life  there  is  a  tendency  in  cer- 
tain types  of  young  girls  to  develop  what  is  known  as 
hysterical  phenomena.  Now,  it  is  well  to  know  that 
what  is  understood  as  hysteria  by  physicians  is  not 
merely  those  attacks  which  people  call  hysterics. 

Physicians  frequently  hear  this  reply,  "  But,  doctor, 
my  daughter  is  not  hysterical ;  she  is  of  the  most 
amiable  disposition  ;  I  know  her  to  be  extremely  brave 
and  fearless."  At  the  same  time  she  may  be  a  marked 
subject  of  hysterical  vomiting,  or  some  of  the  pa- 
ralyses. It  is  a  difficult  matter  to  decide  whether  these 
troubles — which  are  usually  termed  reflex  by  doctors, 
because  they  are  sympathetic  or  reflected  from  other 
organs  through  the  chain  they  have  in  common,  the 
delicate  nervous  system — are  due  to  disturbance  in  the 
womb,  or  are  simply  the  result  of  an  associated  weak- 
ness, of  which  the  disturbed  menstruation,  the  pain,  or 
diminished  quantity  of  the  flow  is  another  evidence. 

In  many  cases  the  womb-troubles,  which  may  simply 
be  the  irregularity  of  the  function  of  menstruation,  may 
be  the  cause,  and  rest,  hot  foot-baths,  electricity,  etc., 
bring  about  a  cure ;  or  it  may  be  due  to  weakness  on 


PUBERTY.  207 

the  part  of  the  individual,  poor  blood,  deficient  out- 
door employment,  too  much  standing,  as  is  so  common 
with  store-girls,  and  only  yield  to  tonics,  fresh  air,  ample 
diet,  and  exercise. 

What  are  generally  understood  as  hysteria  by  the  non- 
professional are  the  outbursts  from  the  nervous  system 
upon  the  slightest  irritation,  whether  pleasurable  or 
painful.  To  a  certain  extent  this  is  independent  of 
any  disease  or  even  disorder  of  the  generative  system, 
and  is  solely,  I  regret  to  have  to  say,  due  to  bad 
"bringing-up."  Gentle,  over-indulgent  parents  are 
themselves  the  cause  of  such  a  state  of  affairs. 

It  is  not  for  us  to  study  the  cause  of  these  changes 
in  individuals  that  produce  this  function,  nor  to  de- 
scribe the  anatomy  and  physiology  of  the  organs  that 
are  engaged  in  it.  It  is  merely  necessary  to  insist  upon 
the  fact  that  normal  menstruation  should  be  painless, 
and  that  disturbances  occurring  at  this  time,  whether 
in  the  form  of  local  pain,  headache,  or  lassitude,  bear  the 
same  relation  to  normal  menstruation  that  discomfort, 
nausea,  and  pain  bear  to  healthy  digestion.  Just  as  dys- 
pepsia is  dependent  upon  indiscretion  in  diet,  or  weak- 
ened digestion  from  debility,  so  difficult  or  painful 
menstruation  is  the  result  of  indiscretion  at  the  time 
when  care  and  watchfulness  should  be  the  rule,  or  it  is 
the  penalty  paid  for  neglect  at  some  earlier  period. 

Debility  in  early  girlhood  is  one  of  the  principal 
causes  of  pain  when  the  function  is  established.  It  is 
usually  found  in  rapidly-growing  girls  whose  tastes 
have  led  them  enthusiastically  into  literary  pursuits, 
partly  from  a  feeling  on  their  part  that  their  muscular 
weakness  will  prevent  their  taking  pleasure  in  the 
rough  out-door  pleasures  of  their  more  robust  com- 
panions, and  partly  from  the  extreme  excitability  of 
their  nervous  system,  which  makes  them  at  an  early 
age  noted  for  their  brilliancy,  and  which  also  will 
exaggerate  their  liability  to  pain.     Such  children  are 


208  CHILDHOOD. 

easily  recognized,  and  to  them  the  watchful  mother 
should  give  her  careful  attention  in  anticipation  of 
what  their  development  will  bring  forth.  Their  studies 
should  be  gently  directed  towards  those  pursuits  that 
lead  them  out  of  doors ;  the  muscular  exercise  involved 
in  household  duty  should  be  gradually  given  them ; 
habits  of  early  rising  and  early  to  bed  should  be  insisted 
upon.  There  should  be  a  judicious  division  of  their 
school-hours,  the  selection  of  well-ventilated  and  bright 
school-rooms,  daily  gymnastic  exercise,  swimming,  rid- 
ing on  horseback,  and  walks, — not  the  aimless  prom- 
enading the  streets,  but  walks  that  are  calculated  to 
give  both  pleasure  and  profit.  There  is  no  better 
way  of  making  healthy  girls  than  to  make  the  various 
branches  of  science  according  to  their  taste  a  part  of 
their  education ;  there  is  not  a  girl,  or  in  fact  any  in- 
dividual, who  has  not  a  latent  taste  which  cannot  be  with 
a  little  care  developed.  If  fond  of  drawing  or  paint- 
ing, encourage  it  from  the  earliest  moment ;  teach  her 
to  draw  from  nature,  and  she  will  spend  hours  in  the 
open  air.  Botany,  mineralogy,  photography,  will  em- 
brace the  repertoire  of  an  educated  woman  as  well  as 
Latin  and  Greek,  and  a  woman's  mind  is  capable  of 
accommodating  them  all,  if  necessary. 

Unfortunately,  the  present  fashion  is  totally  at  vari- 
ance, strange  to  say,  with  that  of  the  ancient  days  of 
Greece  and  Rome.  Now  a  person  can  learn  nothing 
except  in  an  ill-ventilated  school-room,  in  a  barrel-hoop 
position.  The  philosophers  of  ancient  days  studied  as 
hard  as  those  of  modern  times,  but  they  sought  the 
solitude  of  the  woods,  and  made  their  studies  a 
pleasure  instead  of  a  task.  It  is  not  intense  study 
that  breaks  so  many  down ;  it  is  the  confined  air,  the 
sitting  in  a  bent  posture,  the  loss  of  appetite,  the 
muscular  weakness,  and  the  poor  blood  that  does  the 
harm.  I  wish  I  could  impress  firmly  upon  mothers 
the  importance  of  an  erect  carriage  in  young,  growing 


PUBERTY.  209 

girls.  It  is  not  merely  the  case  that  stooping  shoulders 
and  curved  spines  make  their  daughters  unattractive 
in  appearance,  but  that  such  conditions  are  absolutely 
a  predisposing  cause  of  disease;  and  I  am  satisfied 
from  personal  observation  that  such  girls  are  always 
more  or  less  affected  with  painful  periods.  To  correct 
this  before  the  age  of  puberty  should  be  the  aim  of 
every  mother.  Make  your  girls  from  habit  straight, 
with  shoulders  well  thrown  back,  and  they  will  avoid 
many  womb-troubles  in  the  future.  If  out-door  ex- 
ercise does  not  seem  to  correct  this  habit,  there  are 
certain  movements  of  the  muscles — light  gymnastics — 
which  your  family  physician  can  tell  you  of  that  are 
beneficial.  One  of  the  straight  est  and  best-formed  girls 
I  ever  saw,  a  picture  of  health,  owed  it  all  to  her  mother, 
who,  noticing  a  gradual  habit  of  stooping,  required  her 
to  lie  flat  on  her  back  on  the  floor  without  a  pillow  for 
one  hour  each  day,  while  she  read  some  entertaining 
book  to  her.  Another  matter  which  is  important  in 
this  connection  is  the  question  of  young  girls  wearing 
corsets.  Fortunately,  so  much  attention  has  been  paid 
lately  to  the  subject  of  dress  in  England,  that  those 
whose  opinion  is  most  valuable  have  freely  expressed 
themselves.  I  cannot  but  fully  endorse  the  statement 
of  the  London  Lancet  recently,  that  corsets  should  not 
be  worn  by  young  women ;  their  dress  should  always 
be  made  so  as  to  give  free  and  independent  movement 
to  every  part  of  the  body;  their  garments  should  be 
light  in  weight,  and  the  burden  should  fall  as  much  as 
possible  on  the  shoulders ;  there  should  be  no  restric- 
tion of  any  part  of  the  body,  and  if  a  girl's  figure  needs 
a  corset  to  make  it  shapely,  let  her  endeavor  to  accom- 
plish the  same  end  by  the  more  natural  means  of  mus- 
cular development,  which  will  at  the  same  time  give 
health  as  well  as  beauty.  A  strong  back  is  far  better 
than  a  corset. 

Young  girls  should  know  that  when  the  time  comes 
o  18* 


210  CHILDHOOD. 

for  their  period  they  should  avoid  everything  that  would 
either  postpone  it  or  make  it  painful.  If  a  horseback 
excursion  has  been  fixed  for  that  time,  some  excuse 
must  be  made;  if  a  boating-party  involve  exposure 
to  the  night  air,  by  all  means  avoid  it.  In  avoiding 
extremes,  one  does  not  merely  mean  the  extreme  of 
doing  too  much,  but  also  that  of  doing  too  little.  The 
lounging  about  one's  bedroom,  or  spending  the  whole 
day  sitting  reading  a  novel,  will  be  as  apt  to  give 
trouble  as  the  opposite  extreme ;  it  will  make  the  cir- 
culation sluggish,  tend  to  headache,  make  the  liver 
torpid,  give  rise  to  indigestion,  and  weaken  the  system. 
If  one  is  accustomed  to  moderate  exercise,  the  daily 
avocations  of  life  should  not  be  interfered  with ;  but 
heavy  lifting  or  over-fatigue  in  walking,  or  too  long 
standing,  riding  on  horseback,  or  dancing,  should  be 
carefully  avoided. 

I  cannot  lay  too  much  stress  on  the  importance  of  a 
careful  regulation  of  the  bowels,  especially  in  its  bearing 
upon  the  disorders  of  women.  Every  one  knows  the 
necessity  of  establishing  a  daily  habit,  from  the  fact  that 
the  wastes  of  the  body  which  are  discharged  through 
the  intestine,  if  allowed  to  remain,  decompose,  are  re- 
absorbed and  produce  a  certain  poisoned  condition  of 
the  system,  made  evident  by  furred  tongue,  nausea, 
distaste  for  food,  disagreeable  taste  in  the  mouth,  head- 
aches, bad  complexion,  pimples,  and  other  disorders  of 
the  skin,  rendering  the  individual  miserable  to  herself 
and  others.  Constipation  also  allows  an  accumulation 
to  take  place  in  the  bowel,  which  by  distending  it  will 
press  upon  the  organs  that  lie  in  contact,  and  cause  the 
extreme  pain  so  common  at  times,  especially  in  the  left 
side.  Nothing  should  interfere  with  this  daily  duty ; 
but  no  one  should  use  powerful  purgatives  without  con- 
sulting a  physician. 

The  varieties  of  disordered  menstruation  are  known 
as  amenorrhcea,  dysmenorrhea,  and  Menorrhagia;  the 


PUBERTY.  211 

former  meaning  absence  of  menstruation,  the  second 
difficult  or  painful  menstruation,  and  the  third  an  un- 
usual flow  at  that  time.  Delayed  menstruation — that 
is,  where  a  young  girl  has  reached  say  the  age  of  nine- 
teen without  the  appearance  of  the  flow — is  apt  to  give 
rise  to  much  anxiety.  If  this  is  associated  with  evi- 
dences of  tardy  sexual  development,  it  is  not  of  itself 
alarming,  and  cases  are  on  record  where  women  have 
married  and  given  birth  to  children  without  ever  hav- 
ing menstruated.  But  it  is  always  well,  and  especially 
if  occasional  signs  are  present  of  an  attempt  at  the 
establishment  of  menstrual  flow,  not  to  allow  this  state 
of  affairs  to  run  on  long.  The  family  physician  should 
be  consulted,  as  the  obstacle  may  be  a  mechanical  one, 
or  certain  causes  exist  which  could  be  readily  removed, 
but  which  otherwise  might  lead  to  serious  disease.  It 
is  a  recognized  fact  that  the  general  mortality  of  women 
is  increased  at  this  period  of  life,  and  as  soon  as  the  es- 
tablishment of  the  menstrual  flow  takes  place  the  mor- 
tality shows  a  reduction.  In  the  cases  just  mentioned 
it  will  be  readily  understood  that  to  attempt  to  bring 
on  the  period  by  hot  baths,  poultices,  or  especially  by 
the  severe  and  forcible  means  of  powerful  drugs  ob- 
tained without  the  doctor's  consent,  would  be  harmful, 
even  fatal,  and  I  regret  to  say  that  many  such  accidents 
happen.  Dr.  Mathews  Duncan  thus  writes  of  delayed 
menstruation :  "  Like  other  processes  of  development, 
that  of  the  generative  system  admits  of  considerable 
variation  in  point  of  time,  without  of  necessity  passing 
the  limits  of  health.  Indeed,  just  as  one  child  cuts  its 
first  tooth  at  seven  months  and  another  not  till  a  year 
old,  so  one  girl  will  menstruate  at  fourteen  to  fifteen, 
and  another  not  till  seventeen."  Weakness  or  feeble- 
ness of  constitution,  more  or  less  the  result  of  city  life, 
may  be  in  itself  another  cause  for  this  condition.  I 
quote  again  from  the  above  author  : 

"A  girl  previously  in  good  health  approaches  the 


21 2  CHILDHOOD. 

time  of  puberty,  some  of  the  changes  characteristic  of 
it  take  place  :  the  form  assumes  the  contour  of  woman- 
hood, and  nothing  but  the  occurrence  of  menstruation 
is  wanting  to  announce  the  completion  of  the  change. 
The  menses,  however,  do  not  show  themselves,  but  the 
girl  begins  to  suffer  from-  frequent  headaches ;  and  the 
flushed  face,  frequent  backache,  pains  in  the  lower  por- 
tion of  the  abdomen,  constipation,  a  furred  tongue  and 
a  full  pulse,  and  all  these  signs  of  constitutional  disor- 
der undergo  a  marked  increase  at  stated  periods  of  about 
a  month.  At  length  menstruation  occurs,  though  in  all 
probability  scantily,  and  attended  with  much  pain,  and 
then  for  several  months  together  there  is  no  sign  of  its 
return.  The  general  health  was  at  first  probably  not 
seriously  disturbed,  but  by  degrees  the  patient  becomes 
habitually  ailing,  the  appetite  falls  off,  the  powers  of 
digestion  are  weakened,  the  strength  becomes  unequal 
to  ordinary  exertion,  the  pulse  grows  feeble  and  fre- 
quent, and  the  face  itself  assumes  a  pallid,  sallow  tinge, 
whence  the  term  '  chlorosis/  '  green  sickness,'  has  been 
selected;"  and  it  might  be  added  that  such  patients 
are  not  by  any  means  of  necessity  thinner  than  usual. 
The  great  mistake  most  people  make  is  to  attribute  this 
to  disorder  of  the  liver;  they  call  it  biliousness,  and  are 
apt  to  do  harm  by  overdosing  for  this  supposed  condi- 
tion. Again,  they  will  imagine  languor  represents 
weakness,  and  immediately  have  recourse  to  some  strong 
preparation  of  iron  or  the  inevitable  dose  of  quinine, 
and  then  seem  surprised  that  no  improvement  follows. 
It  is  the  tonic  influence  of  fresh  air,  healthful  pursuits, 
exercise  short  of  fatigue,  and  a  nourishing,  wholesome 
diet,  of  which  milk  should  form  the  essential  feature, 
that  does  most  good,  aided  by  those  drugs  which  the 
investigation  of  the  careful  physician  has  warranted  his 
suggesting  to  aid  nature. 

In  the  treatment  of  this  form  of  difficult  menstrua- 
tion, which  is  applicable  as  well  to  those  cases  where 


PUBERTY.  213 

from  one  cause  or  another  the  period  has  been  missed 
by  an  ordinarily  healthy  girl,  either  from  exposure  to 
cold  or  the  result  of  some  shock  to  the  system,  it  might 
be  the  debility  consequent  upon  convalescence  from 
fever,  or  some  such  cause,  Dr.  Duncan  says,  "  The  pa- 
tient should  be  kept  quiet,  and  if  there  is  any  consider- 
able suffering  or  much  disturbance  of  the  circulation,  it 
is  desirable  that  she  remain  in  bed,  while  the  hot  hip- 
bath night  and  morning,  rendered  still  more  stimulat- 
ing in  cases  where  the  local  pain  is  not  considerable  by 
the  addition  of  some  mustard."  A  gentle  laxative 
should  be  administered,  such  as  a  dessertspoonful  of  the 
compound  liquorice  powder,  or  a  dose  of  magnesia  or 
phosphate  of  soda,  or,  better  than  all,  probably,  a  dose 
of  castor  oil,  preceded  by  a  couple  of  Lady  Webster 
pills  at  night.  Should  there  be  much  pain,  hot  appli- 
cations to  the  abdomen,  either  in  form  of  a  light  meal 
poultice  or  a  flannel  bag  of  hops  wrung  out  frequently 
in  hot  water,  in  addition  to  a  hot  foot-bath.  Under  no 
circumstances  whatever  should  the  powerful  irritants 
sold  in  the  drug-shops  for  such  purposes  be  used ;  all 
drugs  should  be  left  for  the  physician  to  order.  The 
use  of  hot  teas  is  recommended, — ginger  tea,  tansy  tea, 
etc., — and  by  such  means  endeavor  to  encourage  and 
not  force  the  habit  of  menstruation.  An  excellent  tea 
can  be  made  from  powdered  ginger,  senna,  and  dul- 
camara ;  it  is  laxative,  and  can  be  used  every  night  with 
no  bad  effects. 

The  subject  of  pain  during  this  time  next  claims  our 
attention.  At  times  it  is  so  intense  as  to  demand  im- 
mediate relief;  and  frequently  persons,  especially  those 
who  have  not  the  mother's  care  or  her  experience  to 
guide  them,  will  put  off  month  after  month  the  con- 
sultation with  their  physician,  hoping  that  time  will 
bring  relief,  and  endeavor  by  various  means  to  strug- 
gle through  the  times  which  to  them  bring  renewed 
horrors,  and  finally  wear  them  out  with  the  constant 


214  CHILDHOOD. 

effort  to  withstand  the  pain.  And  what  means  do  they 
adopt  to  obtain  relief?  I  regret  to  say  it,  little  re- 
flection is  given  to  the  cause  of  the  disturbance.  The 
period  once  over,  they  assume  the  same  habits  which 
have  resulted  in  making  a  function  normally  painless 
fraught  with  pain ;  the  same  giddy  life  of  society  or 
the  same  over-indulgence  in  mental  excitement  and  all 
that  tends  to  enervate  both  body  and  mind.  The 
cause  of  their  trouble  never  for  a  moment  attracts  their 
serious  attention ;  the  treatment  that  they  apply  for 
their  relief  consists  only  in  that  which  dulls  their  sen- 
sibility and  deadens  their  nervous  system.  Alcohol  in 
some  form,  whether  gin  or  brandy,  and  opium,  bromides, 
or  chloral,  are  used  in  large  amounts,  and  made  to  play 
the  part  of  the  greatest  curse  of  a  household. 

I  do  not  mean  to  say  that  all  those  who  suffer  do  so 
on  account  of  indiscretion,  nor  do  I  believe  that  the 
most  rigorous  and  careful  living  would  at  once  relieve 
the  tendencies  to  periodical  pain ;  but  I  cannot  dwell 
forcibly  enough  upon  the  fact  that  those  whose  temper- 
ament is  such  that  the  slightest  cause  will  result  in 
hours  of  torture,  can  be  in  time  relieved  by  rest,  nutri- 
tious diet,  and  careful  living. 

If  there  be  one  cause  more  frequent  than  others  to 
which  the  agony  of  the  period  is  due,  it  is  constipa- 
tion ;  and  I  feel  satisfied  that  nine  out  of  ten  sufferers 
owe  their  trouble  to  this  cause.  When  the  question  is 
asked,  they  will  positively  assert  that  their  bowels  are 
moved  daily  with  regularity ;  .but  probably  a  very  small 
portion  of  the  matter  contained  is  passed,  and  a  large 
amount  remains  accumulated,  which  presses  against  the 
tender,  congested  ovary  as  a  morsel  of  food  or  a  filling 
presses  on  the  sensitive  nerve  of  an  inflamed  tooth,  and 
causes  the  severest  form  of  neuralgia.  I  have  not  gone 
deeply  into  this  subject,  but  have  been  sufficiently  ex- 
plicit to  permit  any  one  to  understand  this  matter  so  as 
to  prevent  it.     By  the  frightful  abuse  of  stimulants, 


PUBERTY.  215 

though  the  habit  is  brought  about  without  a  thought  on 
the  part  of  the  sufferer,  she  is  doing  herself  a  most 
grievous  wrong ;  month  after  month,  each  time  increas- 
ing the  dose,  she  will  have  recourse  to  her  bottle  of 
gin,  her  mixture  of  morphia,  or  her  bottle  of  chloral, 
until  finally  she  recognizes  the  unfortunate  fact  that  she 
has  become  a  victim  to  its  use.  It  is  far  better  to 
begin  by  a  firm  determination  of  avoiding  them  at  the 
onset. 

Yon  want  to  relieve  a  congestion  and  bring  on  the 
flow.  To  do  this,  hot  cloths  or  poultices  to  the  abdo- 
men, hot  salt-bags  to  the  back,  hot  hip-bath  and  foot- 
bath, rest  in  bed  or  lounging  around  one's  room  in 
loose  clothing ;  or  if  the  pain  is  not  too  severe,  a  mod- 
erate walk,  or  an  agreeable  change  that  will  take  the 
mind  off  themselves,  and  calm  the  nervous  system  by 
pleasant  thoughts.  The  next  thing  should  be  the  ad- 
ministration of  a  laxative,  and  probably  the  best  of  all 
is  an  enema  which  will  secure  the  thorough  removal  of 
matter  that  may  be  the  cause  of  trouble.  A  thin  gruel 
may  be  used,  made  of  oatmeal  and  strained.  Of  this 
about  a  quart  should  be  used,  or  the  ordinary  Castile 
soap  and  water.  If  mothers  who  are  solicitous  about  the 
well-being  of  their  daughters  would  gain  their  confi- 
dence at  these  times,  and  minister  to  them  during  their 
hours  of  pain,  applying  those  remedies  which  their  ex- 
perience has  proved  valuable,  there  would  be  far  less 
suffering  and  far  less  danger  of  the  habitual  use  of 
drugs  that  can  be  hidden  in  some  convenient  closet 
and  taken  ad  libitum.  Frequently  the  pain  is  so  se- 
vere that  a  physician  is  called  in,  who  gives  a  pre- 
scription, a  strong  anodyne  in  a  pleasing  mixture,  or 
suppositories  of  opium.  The  relief  is  magic ;  the  pa- 
tient falls  into  a  quiet  sleep,  and,  barring  the  nausea 
and  headache  of  the  following  day,  is  surprised  at  the 
result.  A  copy  of  the  prescription  is  obtained,  and  it 
serves  ever  after  foi  herself  and  friends.    This  is  wrong, 


216  CHILDHOOD. 

and  every  right-minded  woman  should  feel  that  to  ex- 
pose herself  to  a  habit  of  this  kind  is  to  sacrifice  her 
life  to  a  slavery  which  ends  only  in  the  grave.  It  is 
far  better  to  consult  the  family  physician  at  once,  tell 
him  frankly  and  without  hesitation  what  the  trouble 
is.  It  is  an  old  story  to  him ;  he  has  listened  to  many 
lectures  upon  it,  he  has  recited  your  symptoms  in  class, 
he  has  heard  the  tale  often  told,  until  it  has  as- 
sumed a  very  monotonous  sound.  You  imagine  that 
the  matter  is  too  delicate  a  one  to  speak  of  without 
embarrassment,  but  you  forget  that  the  position  your 
family  physician  holds  towards  you  is  one  so  intimate 
and  confidential,  so  sacred  in  its  association,  that  it  has 
received  the  sanction  of  heaven  itself,  as  you  are  bidden 
to  obey  him. 

The  severest  form  of  painful  menstruation  is  that 
which  occurs  in  young  women  whose  period  has  not 
appeared  till  much  later  age  than  usual.  "  The  pain 
in  such  cases  precedes  menstruation  for  a  day  or  two, 
generally  reaches  its  greatest  intensity  in  the  course  of 
the  first  thirty-six  hours  of  the  flow,  being  sometimes 
so  intense  that  the  patient  writhes  in  agony,  and  then 
often  by  degrees  subsides,  though  it  does  not  cease 
entirely  till  the  period  is  over,  though  severest  in  the 
uterine  and  pelvic  regions  (lower  part  of  the  abdomen). 
The  pain  is  not  generally  limited  to  these  situations, 
but  is  experienced  also  in  the  back  and  loins,  and 
shoots  down  the  inside  of  the  thigh.  The  pain,  too, 
is  aggravated  at  intervals,  and  becomes  paroxysmal  like 
colic;  and  the  whole  abdominal  surface  is  so  tender 
as  scarcely  to  bear  the  slightest  touch.  Intense  head- 
ache is  very  frequent,  often  confined  to  one  side  of  the 
head ;  and  in  other  cases  the  stomach  is  disordered  and 
the  patient  distressed  by  constant  nausea  and  vomit- 
ing." The  treatment  may  be  summed  up  as  follows : 
absolute  rest  before  the  period  is  expected,  avoidance 
of  any  active  enterprise,  running  up  and  down  stairs, 


PUBERTY.  217 

horseback  exercise,  tennis,  long  walks,  and  sudden 
changes  of  temperature;  to  have  the  bowels  moved 
freely  by  compound  liquorice  powder  or  some  such  sim- 
ple laxative.  Exposure  to  cold  is  very  apt  to  bring 
this  on,  and  it  is  especially  liable  to  occur  in  girls  who 
sit  out  of  doors  after  dark  with  their  thin  summer  cloth- 
ing, and  allow  the  damp,  cool  air  after  nightfall  to  chill 
the  surface  before  the  expected  period.  This  is  fre- 
quently noticed  at  the  sea- shore.  How  many  of  the 
gayly-dressed  beauties,  in  their  lightest  clothing,  will 
dance  a  waltz  through  and  then  rush  frantically  for  a 
walk  on  the  porch,  and  will  next  day  suffer  tortures  in 
their  rooms  for  their  imprudence,  while  their  friends 
marvel  at  the  number  of  sick  headaches  they  seem  to 
have.  Sleep,  rest, — absolute  rest  in  bed, — hot  foot- 
baths prolonged  and  frequently  repeated,  a  strong,  hot, 
well-seasoned  cup  of  beef  tea,  is  the  best  means  of  pro- 
curing relief.  If  the  pain  still  continue,  a  hot  lemonade 
with  a  teaspoonful  of  sweet  spirits  of  nitre  to  the 
tumbler.  The  applications  to  the  surface  of  the  abdo- 
men are  usually  valuable  on  account  of  their  warmth ; 
a  mush  poultice  well  sprinkled  with  laudanum  is  use- 
ful, or  a  bag  of  hops  quilted  and  wrung  out  frequently 
in  hot  water  and  saturated  with  laudanum,  or  wet  with 
the  spirits  of  chloroform.  Frequently  a  hot  salt-bag 
to  the  back  will  give  relief,  or  the  rubber  bag  filled 
with  hot  water.  Should  the  pain  still  remain  severe 
notwithstanding  these  domestic  remedies,  the  physician 
should  be  sent  for  and  the  matter  fully  explained  to 
him. 

There  is  another  form  of  painful  menstruation  which 
is  less  apt  to  occur  at  an  early  period  of  life,  and  is 
recognized  by  the  following  symptoms,  according  to 
Dr.  Duncan  :  "  During  the  first  twenty-four  or  thirty- 
six  hours  of  each  menstruation  the  discharge  in  general 
is  but  scanty,  and  the  pain  is  very  severe.  At  the  end 
of  this  time,  however,  sometimes  sooner,  the  hemor- 
k  19 


218  CHILDHOOD. 

rhage  often  becomes  abundant,  and  as  the  blood  flows 
the  pain  again  abates  and  then  ceases  altogether.  In 
some  of  the  cases,  the  discharge  having  continued  for  a 
few  hours  ceases,  and  then  comes  on  again,  while  though 
scanty  it  is  intermixed  with  small  '  clots.' " 

In  these  cases  anodynes  no  longer  furnish  the  ready 
relief  which  follows  their  administration  in  the  neural- 
gic form.  There  are  so  many  causes  for  this  form  of 
dysmenorrhea,  that  the  physician  should  at  once  be 
consulted,  in  order  that  the  proper  treatment  may  be 
instituted  before  the  next  period.  Laxatives,  such  as 
the  various  purgative  waters,  give  relief  in  these  cases ; 
the  granular  effervescent  Carlsbad  salt,  a  tablespoonful 
in  water,  may  be  taken,  or  a  claret  glass  of  Hunyadi 
water,  or  Friedrichshall  water  with  an  equal  part  of  hot 
water.  A  free  purgative  action  of  the  bowels  should 
be  the  first  thing  to  accomplish.  If  a  patient  is  away 
from  a  physician,  she  should  take  a  tablespoonful  of 
liquor  ammonise  acetatis  during  the  painful  time,  when 
the  flow  is  scanty,  in  some  weak  hot  lemonade  every 
two  hours,  until  three  or  four  doses  have  been  taken. 

It  is  so  obviously  the  mother's  duty  to  be  the  con- 
fidant of  her  child  while  nature  is  establishing  these 
physiological  processes,  that  I  have  felt  the  necessity  of 
adding  this  chapter  to  my  book.  Most  of  the  dis- 
orders of  the  nervous  system  which  attend  this  time  of 
life  are  directly  traceable  to  indiscretions  which  are  the 
result  of  ignorance.  The  intellectual  girl  of  sedentary 
habit  offends  nature  by  retarding  her  physical  develop- 
ment. The  thoughtless  enthusiast  lays  the  seed  of  fu- 
ture disorders  by  an  ignorance  which  the  timely  ad- 
monition of  a  watchful  mother  would  avoid. 


INDEX. 


Air,  87,  91. 

Air-passages,  diseases  of,  151. 
Amenorrhoea,  210. 
Anodynes,  abuse  of,  95,  214. 
Aperients,  45,  124. 
Aphthse,  111. 
Atomizer,  133,  153. 
Attitudes,  unhygienic,  209. 

Baby-basket,  34. 

Barley  as  infants'  food,  71. 

Bathing,  94,  97. 

during  pregnancy,  21. 
Binder,  35,  39. 
Bone,  102,  195. 
Bottle,  55,  66. 
Bottle-feeding,  50,  66,  85. 
Bowels,  116. 
Breasts,  care  of,  32. 

changes  in,  during  gestation, 
14. 

Calisthenics  for  children,  199. 

for  girls,  203. 
Carnrick's  Soluble  Pood,  81. 
Catarrh,  nasal,  127. 

of  stomach  and  boweb,  168. 
Cerumen,  141. 
Childhood,  126. 
Child's  nurse,  94. 
Chlorosis,  202,  211. 
Cholera  infantum,  168,  169. 
Cleanliness,  186. 
Clothing,  children's,  198. 

during  pregnancy,  31. 

infantile,  40. 

of  young  children,  199. 
Colds,  87,  127. 
Colic,  124. 
Condensed  milk,  59. 
Confinement,  14,  34. 

probable  date  of,  13. 
Congestion,  how  to  relieve,  215. 


Constipation  in  pregnancy,  23. 

effect  of,  on  nursing  child,  44. 

infantile,  116. 

as  a  cause  of  uterine  disease, 
210. 

as  a  cause  of  monthly  pain, 
214. 
Convulsions,  infantile,  110. 
Corsets  for  girls,  209. 

in  pregnancy,  30. 
Cows'  milk,  52,  66. 
Cramp,  how  to  relieve,  26. 
Cravings  in  pregnancy,  18,  21. 
Creeping,  105. 
Croup,  151,  155,  157. 

Date  of  confinement,  how  to  com- 
pute, 13. 
Debranned  flour,  70. 
Dentition,  100,  112. 

second,  191,  201. 
Diapers,  198. 
Diarrhoea,  164. 
Diet  before  confinement,  21. 

after  confinement,  42. 

after  early  dentition,  112. 
Digestion,  66. 
Diphtheria,  151,  157. 
Disinfectants,  159,  163,  185. 
Douche,  nasal,  132. 
Dress  in  pregnancy,  30. 

of  children,  198. 

of  infants,  40. 
Dysmenorrhoea,  210,  216. 
Dyspepsia  in  pregnancy,  17. 

Ear,  diseases  of,  135. 

Earache,  135,  143. 

Education,  208. 

Emotions,  their  effect  on  offspring, 

Enemata,  25,  121. 
in  pregnancy,  25. 

219 


220 


INDEX. 


Epistaxis,  133. 

Exercise  before  confinement,  27. 

children's,  87. 

for  young  girls,  208 
Eye,  diseases  of,  144. 

Fairchild  on  peptonized  food,  74. 
Farinaceous  foods,  82. 
Flour-ball,  69,  71. 
Food  after  dentition,  115,  197. 
infants',  50,  56,  65,  69,  80. 
Foods,  prepared  commercial,  80. 
Foot-bath,  112. 

Gastric  juice,  67. 

Gestation,  the  troubles  of,  14. 

diet  in,  21. 

not  a  disease,  16. 
Girls  at  first  menstruation,  200. 
Gum-arabic  water  as  food,  82. 
Gums,  lancing,  111. 

Hardening  of  children,  155. 
Hygiene  of  gestation,  21. 
Hysterical  symptoms,  206. 

Ideal  mother,  34. 

Impressions,   their    effect    on    off- 
spring, 33. 
Indigestion  of  pregnancy,  17. 

of  infancy,  70. 

of  childhood,  122. 
Infancy,  38. 
Infant,  40. 

Lactation,  42. 
Laxatives,  45,  124. 

at  menstrual  period,  212. 
Leeds's,  A.  R.,  preparation  of  milk, 

73. 
Lemonade  of  peptonized  milk,  76. 
Liebig's  foods,  82. 
Lime-water,  57,  65. 

Malt  liquors  in  lactation,  43. 

Mammary  glands,  32. 

Maternity,  13. 

Measles,  186. 

Meigs,  A.  V.,    his  preparation  of 

milk  for  the  bottle,  64. 
Membranous  croup,  157. 


Menorrhagia,  210. 
Menstruation,  delayed,  216. 

disordered,  210. 

first,  203,  211. 

painful,  213,  216. 
Milk,  boiled,  72. 

condensed,  59. 

cows',  52,  66. 

"evaporated,"  59. 

humanized,  78. 

mother's,  42. 

mother's,  as  affected  by  diet 
and  medicines,  43. 

peptonized,  75. 

to  cheek  the  flow  of,  43. 
Milk-foods,  80,  81. 
Milk-jelly,  peptonized,  76. 
Miscarriage,  36. 
Monthly  nurse,  35. 
Morning  sickness,  19. 
Mother,  the  ideal,  34. 

Nasal  catarrh,  127. 

douche,  132. 
Nausea  in  pregnancy,  19. 
Navel,  care  of,  39. 
Nestle's  Food,  81. 
New-born  infant,  38,  40. 
Nipple  for  nursing-bottle,  55. 
Nose-bleed,  133. 
Nose,  blowing  the,  131,  137. 
Nurse,  child's,  93. 

monthly,  35. 
Nursery,  88. 
Nurses,  wet-,  45. 
Nursing,  48. 
Nursing-bottle,  55,  66. 

Oatmeal,  71,  85. 
Ophthalmia,  144. 
Out-door  exercise,  87. 
Over-feeding,  108,  164. 

Pain,  how  treated,  213. 
Pancreatic  extract,  74. 
Parker,  W.  T. ;  his  method  of  pre- 
paring milk,  58. 
Peptogenic  Milk  Powder,  73. 
Peptonization,  74. 

of  milk,  75,  77. 
Perambulators,  93. 
Plants,  92. 
Pond's  Extract,  134. 


INDEX. 


221 


Pre-digestion,  73. 
Pregnancy,  13. 

diet  of,  21. 

is  not  a  disease,  16. 
Pregnant  woman's  duties  towards 

her  offspring,  33. 
Premature  labor,  36. 
Puberty,  200. 
Purgatives  during  gestation,  2. 

in  dysmenorrhoea,  216. 

Recreations  of  young  girls,  208. 
Rickets,  102,  196. 
Running  from  the  ear,  138. 

Salt-bath,  97,  105. 

Scarlatina,  180. 

Scarlet  fever,  180. 

Sea-shore,  97. 

Sewerage  pipes,  90. 

Sleep  of  infants,  88. 

Sleeping-room,  90. 

Sleeplessness,  106,  109. 

Smith's  (J.  L.)  formula  for  infants' 

food,  69. 
Snoring,  132. 
Soap,  99. 

Soothing  medicines  for  infants,  95. 
Soup,  peptonized,  76. 


Starchy  foods  for  infants,  70. 
Stimulants  to  be  avoided,  214. 
Syringe,  traveller's,  25. 

Tainted  milk,  51. 

Teaspoon,  how  much  it  holds,  57. 

Teething,  100,  112. 

Throat,  diseases  of,  151. 

Toilet  appliances  for  the  lying-in 

room,  34. 
Traveller's  syringe,  25. 
Twelfth-year  molar  teeth,  20. 

Under-feeding  of  infants,  107. 

Valsalva's  experiment,  137. 
Vaporizer,  use  of,  133,  153. 
Ventilation,  87,  89. 
Vichy  water  in  infants'  milk,  61, 
Vomiting  in  indigestion,  123. 

in  infantile  diarrhoea,  173. 

in  pregnancy,  19. 

Water  for  infants,  165. 
Wax  in  the  ears,  141. 
Weaning,  83. 
Wet-nurses,  45. 
Whey  as  food,  65,  66. 
Whooping-cough,  174. 


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715  and  717  Market  Street,  Philadelnhia. 


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